Machado Norman Oneil
Department of Surgery, Sultan Qaboos University Hospital, P.O. Box 38, Muscat 123, Oman.
Diagn Ther Endosc. 2011;2011:967017. doi: 10.1155/2011/967017. Epub 2011 Jun 12.
Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30° scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.
腹腔镜胆囊切除术已成为治疗有症状胆结石的金标准治疗选择。然而，腹腔镜胆囊切除术的应用与并发症风险增加相关，尤其是胆管损伤，发生率为0.3%至0.6%。胆管损伤的发生会导致重建困难、住院时间延长以及长期并发症的高风险。因此，更强调预防这些并发症。除了充分的培训外，还提出了几种预防胆管损伤的技术，包括使用30°腹腔镜、充分界定胆囊三角区的结构（关键视野）、避免靠近肝总管使用电刀、术中胆管造影，以及在不确定时保持较低的中转开腹阈值。胆管损伤的处理取决于损伤的性质、发现时间和可用的专业知识，范围从简单的肝下引流到Roux-en-Y肝空肠吻合术，特别是在专业中心进行。本文基于文献综述，旨在参考其机制、应采取的预防措施和处理方法，对腹腔镜胆囊切除术后的胆道并发症进行综述。
