Sekido Hitoshi, Matsuo Ken-ichi, Morioka Daisuke, Kunihiro Osamu, Tanaka Kuniya, Endo Itaru, Togo Shinji, Shimada Hiroshi
Department of Surgery II, Yokohama City University, School of Medicine, Yokohama, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):357-61.
BACKGROUND/AIMS: The incidence of biliary injury during laparoscopic cholecystectomy remains high and several complications resulting from injuries have recently been reported. The aim of this study is to elucidate the surgical strategy for the management of biliary injury during laparoscopic cholecystectomy.
Ten patients with biliary injury during laparoscopic cholecystectomy are retrospectively reviewed.
Second operations as initial repair were performed in five patients in our institute. Duct-to-duct anastomosis for one and duct-enterostomies for two were performed in three common bile duct transections. Simple closures were performed for the other two biliary injuries. Another five cases underwent both laparoscopic cholecystectomies and second operations for initial repair when they were referred to our service. Four were treated by a third operation in our institution including hilar bile duct resections and duct-enterostomies in two, and right hepatic lobectomies in the other two cases. The last patient could not be treated because of his poor condition and he died of hepatic failure soon after the consultation.
Complications resulting from biliary injury have recently been reported, necessitating liver transplantation. Laparoscopic surgeons should avoid biliary injury and must not perform inadequate biliary reconstruction, which leads to secondary biliary cirrhosis, cholangitis, liver failure, and finally patient death.
背景/目的：腹腔镜胆囊切除术中胆管损伤的发生率仍然很高，最近有报道称损伤导致了几种并发症。本研究的目的是阐明腹腔镜胆囊切除术中胆管损伤的手术处理策略。
回顾性分析10例腹腔镜胆囊切除术中发生胆管损伤的患者。
我院对5例患者进行了首次修复的二次手术。在3例胆总管横断病例中，1例行胆管对端吻合术，2例行胆管肠吻合术。另外2例胆管损伤行单纯缝合。另外5例患者转诊至我院时，既接受了腹腔镜胆囊切除术，也接受了首次修复的二次手术。4例在我院接受了第三次手术，其中2例行肝门胆管切除术和胆管肠吻合术，另外2例行右肝叶切除术。最后1例患者因病情严重无法治疗，会诊后不久死于肝功能衰竭。
最近有报道称胆管损伤导致并发症，需要进行肝移植。腹腔镜外科医生应避免胆管损伤，且不得进行不充分的胆管重建，否则会导致继发性胆汁性肝硬化、胆管炎、肝功能衰竭，最终导致患者死亡。
