Karimian Faramarz, Aminian Ali, Mirsharifi Rasoul, Mehrkhani Farhad
Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Patient Saf Surg. 2008 Jun 20;2:17. doi: 10.1186/1754-9493-2-17.
Avulsion of cystic duct during laparoscopic cholecystectomy (LC) is not a common intraoperative complication, but may be encountered by any laparoscopic surgeon. Surgeons are rarely familiar with management of this condition.
Patients with gall stone related problems who were scheduled for LC at the minimal invasive surgery unit of a tertiary referral hospital during a 5 years period (April 2002-April 2007) were prospectively enrolled.
12 cases were identified (incidence: 1.15%). All 12 patients had gallbladder inflammation. Five patients had acute and seven patients had chronic cholecystitis. The avulsed cystic duct (ACD) was managed by clipping in 4, intracorporeal suturing in 3, converting to open surgery with suture ligation in 2, and lonely external drainage in 3 patients. Bile leakage had ceased within 3 days in 2, 14 days in one, and 20 days in the other patient. Bile volume increased gradually in one of the patients, which stopped only after endoscopic sphincterotomy (ES) at 25th postoperative day. No major late complication or mortality occurred.
ACD during LC is a rare complication. Almost all standard methods of treatment yield to successful outcomes with low morbidity. According to the situation, ACD may be successfully managed laparoscopically. Available cystic stump remnant was clipped. Intracorporeal suture ligation was performed when short length of stump precluded clipping. Deeply retracted cystic duct with active bile leak led to conversion to open surgery. With minimal or no bile leak at ACD stump, closed tube drainage of sub-hepatic area was attempted. Persistent bile leak was assumed to be controlled by ES, successfully accomplished in one patient.
腹腔镜胆囊切除术（LC）期间胆囊管撕脱是一种不常见的术中并发症，但任何腹腔镜外科医生都可能遇到。外科医生很少熟悉这种情况的处理。
前瞻性纳入了在一家三级转诊医院的微创手术科计划在5年期间（2002年4月至2007年4月）进行LC的胆结石相关问题患者。
确定了12例（发生率：1.15%）。所有12例患者均有胆囊炎。5例为急性胆囊炎，7例为慢性胆囊炎。4例通过夹闭处理撕脱的胆囊管（ACD），3例进行体内缝合，2例转为开放手术并进行缝合结扎，3例患者仅进行外部引流。2例患者的胆漏在3天内停止，1例在14天停止，另1例在20天停止。1例患者的胆汁量逐渐增加，仅在术后第25天进行内镜下括约肌切开术（ES）后才停止。未发生重大晚期并发症或死亡。
LC期间的ACD是一种罕见的并发症。几乎所有标准治疗方法都能取得成功结果，发病率低。根据情况，ACD可通过腹腔镜成功处理。可用的胆囊残端进行夹闭。当残端长度过短无法夹闭时进行体内缝合结扎。胆囊管深度回缩且有活动性胆漏导致转为开放手术。ACD残端胆汁渗漏极少或无渗漏时，尝试对肝下区域进行闭式管引流。持续性胆漏假定通过ES得到控制，1例患者成功完成。
