Zha Yong, Chen Xun-Ru, Luo Ding, Jin Yun
Department of Abdominal Surgery, The Third Affiliated Hospital, Kunming Medical College, Kunming General Hospital, Kunming, China.
Surg Laparosc Endosc Percutan Tech. 2010 Dec;20(6):378-83. doi: 10.1097/SLE.0b013e3182008efb.
Major bile duct injury (MBDI) is one of the most serious complications associated with laparoscopic cholecystectomy (LC). This study reports our experience in preventing MBDI during LC. Between September 1991 and August 2004, 13,000 cases of LC were performed at Kunming General Hospital. Systemic strategies, including selection of proper patients for LC based on the surgeons' experience, dissection techniques in Calot's triangle, selective use of laparoscopic ultrasonography, and indication of conversion to an open approach were developed and introduced to avoid MBDI. In our series, the overall incidence of MBDI was 0.085%, 0.60% (3 of 500) over the first period from September 1991 to September 1992, 0.17% (5 of 3000) over the second period from October 1992 to September 1996, and 0.03% (3 of 9500) over the third period from October 1996 to August 2004. The MBDI included transection of the common bile duct (CBD) due to mistaking CBD for cystic duct (n=6), cautery injury (n=3), laceration of the CBD at the junction of cystic duct and CBD (n=1), and clip partially of common hepatic duct due to blind hemostasis (n=1). The incidence of MBDI in our institution is acceptable. We believe the system strategies are effective to avoid MBDI in LC. LC is a safe procedure with an incidence of biliary injury comparable with that for open cholecystectomy.
主要胆管损伤（MBDI）是腹腔镜胆囊切除术（LC）相关的最严重并发症之一。本研究报告了我们在LC术中预防MBDI的经验。1991年9月至2004年8月期间，昆明总医院共进行了13000例LC手术。我们制定并采用了一系列系统策略，包括根据外科医生的经验选择合适的LC患者、Calot三角区的解剖技术、选择性使用腹腔镜超声检查以及转为开腹手术的指征，以避免MBDI。在我们的病例系列中，MBDI的总体发生率为0.085%，在1991年9月至1992年9月的第一阶段为0.60%（500例中有3例），在1992年10月至1996年9月的第二阶段为0.17%（3000例中有5例），在1996年10月至2004年8月的第三阶段为0.03%（9500例中有3例）。MBDI包括因将胆总管（CBD）误认作胆囊管而导致的CBD横断（n = 6）、烧灼伤（n = 3）、胆囊管与CBD交界处的CBD撕裂伤（n = 1）以及因盲目止血导致的部分肝总管夹闭（n = 1）。我们机构的MBDI发生率是可以接受的。我们认为这些系统策略对于避免LC术中的MBDI是有效的。LC是一种安全的手术，其胆道损伤发生率与开腹胆囊切除术相当。
