Luo Ding, Chen Xun-Ru, Mao Jing-Xi, Li Sheng-Hong, Zhou Zheng-Dong, Yu Shao-Ming
Department of Hepatobiliary Surgery, Kunming General Hospital of PLA, Kunming 650032, China.
Hepatobiliary Pancreat Dis Int. 2003 Aug;2(3):441-4.
The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i.e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy.
The CI was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged.
Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecystectomy, the technique for prevention of misidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted.
Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI.
腹腔镜胆囊切除术中胆管损伤（BDI）的主要原因是将胆总管误认作胆囊管（CD）。本文旨在介绍一种改良技术，即对胆囊漏斗部（CI）-胆囊管交界处进行三维识别，以防止腹腔镜胆囊切除术中因误认导致的BDI。
广泛解剖CI以暴露其前、内上和下背侧。将近似环形地解剖出CI后，可从三维角度识别CI及其外观所示的CI-胆囊管交界处，并能精确判断CI-胆囊管交界处以及胆总管的实际情况。
该组共记录到10例BDI。由于在4382例行腹腔镜胆囊切除术的患者中有8例发生了BDI，因此确立了预防因误认导致BDI的技术。在后期的7618例患者中，仅发现2例BDI。
对CI-胆囊管交界处进行三维识别是一种可靠、可行且相对不依赖经验的技术，可预防大多数因误认导致的BDI。
