Csendes A, Navarrete C, Burdiles P, Yarmuch J
Department of Surgery, Clinical Hospital University of Chile and St. Mary's Clinic, Santiago.
World J Surg. 2001 Oct;25(10):1346-51. doi: 10.1007/s00268-001-0121-5.
The increase of laparoscopic cholecystectomy has resulted in an increase of bile duct injuries. The purpose of this article is to define the types of injury, their occurrence and frequency, and their management by endoscopic and surgical techniques. Three investigations were included in the present study. 1. A 3-year retrospective study among 29 hospitals with 25,007 laparoscopic cholecystectomies. 2. An 8-year prospective study at our institution of 6488 patients. 3. A prospective endoscopic study of 94 patients with injuries and strictures of the common bile duct (CBD) after laparoscopic cholecystectomy. A special classification for bile duct injuries was developed. Among 25,007 patients from 29 hospitals, a total of 74 lesions were detected with an incidence of 0.29%. At our institution, 20 cases were seen (0.29%) with type I, II, and III injuries. The 94 cases managed by endoscopic procedure were submitted to endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy, with placement of several stents 5 to 10 F during 8 months. The results of this procedure have been excellent to good in 76% of the cases up to 3 years of follow-up. According to our previous and present experience, bile duct injuries after laparoscopic procedure are two times higher than after open procedure. The best treatment is the prevention of these injuries by careful surgical technique. If they occur, the best moment to repair them is during surgery. If they are noticed after the operation, endoscopic or surgical procedures can be employed.
腹腔镜胆囊切除术的增加导致了胆管损伤的增多。本文旨在明确损伤的类型、其发生情况和频率，以及通过内镜和手术技术进行的处理。本研究纳入了三项调查。1. 对29家医院的25007例腹腔镜胆囊切除术进行的为期3年的回顾性研究。2. 在我们机构对6488例患者进行的为期8年的前瞻性研究。3. 对94例腹腔镜胆囊切除术后胆总管（CBD）损伤和狭窄患者进行的前瞻性内镜研究。制定了胆管损伤的特殊分类。在29家医院的25007例患者中，共检测到74处损伤，发生率为0.29%。在我们机构，发现了20例I、II和III型损伤（0.29%）。接受内镜手术的94例患者接受了内镜逆行胰胆管造影（ERCP）和乳头切开术，并在8个月内放置了几根5至10F的支架。在长达3年的随访中，该手术的结果在76%的病例中为优至良。根据我们之前和目前的经验，腹腔镜手术后的胆管损伤比开放手术后高出两倍。最佳治疗方法是通过谨慎的手术技术预防这些损伤。如果发生损伤，最佳修复时机是在手术期间。如果在术后发现，可采用内镜或手术方法。
