Schmidt S C, Langrehr J M, Schumacher G, Neuhaus P
Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Universitätsmedizin Berlin, Charite Campus Virchow Klinikum, BRD, Germany.
Rozhl Chir. 2005 Nov;84(11):567-72.
Injuries of the biliary tract following laparoscopic cholecystectomy have increased with the widespread use of the procedure. Compared to the conventional open choelycstectomy, the incidence of bile duct injuries is at least twofold higher after the laparoscopic procedure. A number of risk factors for the occurrence of bile duct injuries have been well described, including severe inflammation, bleeding, anatomical variations and lack of surgical experience. The appropriate management of bile duct injuries depends on the time of diagnosis after the injury and the type of injury. While peripheral leakages and short strictures can be treated endoscopically, extended injuries and long strictures require surgical reconstruction. The best long-term results are achieved with a tension-free, end-to-side mucosa-to-mucosa Roux-Y hepaticojejunostomy.
随着腹腔镜胆囊切除术的广泛应用,该手术后胆道损伤有所增加。与传统的开腹胆囊切除术相比,腹腔镜手术后胆管损伤的发生率至少高出两倍。已经详细描述了胆管损伤发生的一些风险因素,包括严重炎症、出血、解剖变异和缺乏手术经验。胆管损伤的恰当处理取决于损伤后的诊断时间和损伤类型。对于周边渗漏和短段狭窄可采用内镜治疗,而广泛损伤和长段狭窄则需要手术重建。无张力、端侧黏膜对黏膜的Roux-Y肝空肠吻合术可取得最佳的长期效果。