Li Li-Bo, Cai Xiu-Jun, Mou Yi-Ping, Wei Qi, Wang Xian-Fa
Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou 310016, China.
Hepatobiliary Pancreat Dis Int. 2005 Feb;4(1):113-6.
The short-term results of repair of laparoscopic bile duct injuries have been well discussed, but the long-term results have been rarely reported. This study was undertaken to evaluate the factors influencing the outcome of repair of bile duct injuries caused by laparoscopic cholecystectomy.
The outcomes of repair of bile duct injuries caused by laparoscopic cholecystectomy in 31 patients were reviewed retrospectively, and the effects of injury recognition, cholangiography, repair modality and techniques on the long-term results were analyzed.
Bile duct injuries were repaired successfully in 19 (95%) of 20 patients with injuries who had been recognized intraoperatively, and in 10 (90%) of 11 patients with injuries who had been recognized postoperatively. Repair was successful in 29 (93%) of the 31 patients after complete cholangiography. Closure of partial division, laceration, or small perforation of the bile duct with or without T tube drainage was satisfactory in the 23 patients. End to end repair over T tube was successful in 2 transection patients, who were detected intraoperatively. Roux-en-Y hepaticojejunostomy was used successfully to repair transection, excision or stricture of the bile duct in 4 of 5 patients (80%).
Early detection of bile duct injuries caused by laparoscopy, complete evaluation of the biliary duct, and appropriate surgical modality and techniques are helpful to improve the results of repair for laparoscopic bile duct injuries.
腹腔镜胆管损伤修复的短期结果已得到充分讨论，但长期结果鲜有报道。本研究旨在评估影响腹腔镜胆囊切除术所致胆管损伤修复结局的因素。
回顾性分析31例腹腔镜胆囊切除术所致胆管损伤的修复结局，并分析损伤识别、胆管造影、修复方式和技术对长期结果的影响。
术中识别出损伤的20例患者中，19例（95%）胆管损伤修复成功；术后识别出损伤的11例患者中，10例（90%）修复成功。31例患者中，29例（93%）在完成胆管造影后修复成功。23例胆管部分断裂、撕裂或小穿孔患者，无论有无T管引流，胆管闭合情况均良好。术中发现的2例横断患者，经T管支撑端端吻合修复成功。5例患者中，4例（80%）成功采用Roux-en-Y肝空肠吻合术修复胆管横断、切除或狭窄。
早期发现腹腔镜所致胆管损伤、全面评估胆管以及采用合适的手术方式和技术有助于提高腹腔镜胆管损伤的修复效果。
