腹腔镜胆囊切除术致胆管损伤分6.doc

腹腔镜胆囊切除术胆管损伤的现状分析 吴青松1 刘吉佳1 谢文彪1 蔡泽平2 1南华大学附属第二医院肿瘤外科 421001 2湖南省郴州铁路医院普外科 423000 【摘要】目的 了解我国当前腹腔镜胆囊切除术胆管损伤发生率、损伤类型和防治现状。方法 通过在中国期刊全文数据库检索1998年至2002年近五年全国各级期刊有关腹腔镜胆囊切除术胆管损伤的论文，统计来自118个医疗单位共487例腹腔镜胆囊切除术胆管损伤。结果 收集189236例腹腔镜胆囊切除术，胆管损伤449例，LC胆管损伤发生率0-5.88%，平均发生率为0.24%，个例腹腔镜胆囊切除术胆管损伤88例。详细记录胆管损伤部位、损伤类型及治疗结果的共487例，其中胆总管损伤228例(46.8%)，胆管损伤类型中以胆管横断伤多见，占250例(51.3%)，复合型损伤142例(29.2%)。术中发现胆管损伤204例(42%)，再手术率为13.8%，再手术原因中以胆管狭窄多见占77.6%，死亡率1.85%。结论 腹腔镜胆囊切除术胆管损伤及损伤后胆管狭窄仍面临着挑战，腹腔镜胆管损伤的特殊性决定其防治效果及预后，减少和防止胆管狭窄是腹腔镜胆囊切除术胆管损伤修复或重建的关键，胆管壁的连续性与完整性应作为LC胆管损伤分类的主体内容。 【关键词】腹腔镜胆囊切除术 胆管损伤 Analysis of Prevention and Treatment on Bile Duct Injury of Laparoscopic Cholecystectomy Wu Qingsong1, Liu Jijia1, Xie Wenbiao1, Cai Zeping2 1.Department of oncosurgery, the Second Affiliated Hospital of Nanhua University, Hunan 421001, China 2.Department of General Surgery, Chenzhou Railway Hospital, Hunan 42300,China 【Abstract】Objective To inverstigate the rate, type, prevention and treatment of bile duct injuries(BDI) following laparoscopic cholecystectomy(LC) in China. Methods Searching articals about BDI following LC in China National Fulltext Datebase between 1998 and 2002 were published in different journals and magazines. Totally 487 cases of BDI from 118 hospitals were analyzed. Results In 189236 cases of LC with 449 cases of BDI, the BDI rate was 0-5.88% and the average rate was 0.24%. Another 88 cases of BDI during LC were collected but its number of LC weren’t noted. 487 cases of BDI with detailed information about the site , type, and effect of prevention and treatment of BDI were collected. With 228 cases (46.8%) of common bile duct injuries and 250 cases(51.3) of bile duct transection were ranked the first place in the site and type of BDI respectively. The combined injury was 142 cases (29.2%) and the number of intraoperative discovery was 204 cases(42%). The reoperative rate was 13.8% and the mortality rate was 1.85%. Postoperative biliary strictures was the main cause for reoperation and the