Rogers Emily A, Tang Shou-jiang, Porter John, Ahmed Naveed
Department of General Surgery, University of Mississippi Medical Center, Jackson 39216, USA.
J Miss State Med Assoc. 2011 Sep;52(9):275-7.
Bile duct injury following laparoscopic cholecystectomy is one of the most feared complications related to performing a cholecystectomy. Early identification and repair can be life saving for patients with bile duct injuries. Since the early 1990s, laparoscopic cholecystecomy (LC) has replaced open cholecystectomy as the preferred treatment of symptomatic cholethiasis, biliary dyskinesia, and cholecystitis. LC has decreased the length of hospital stay and post-operative pain and resulted in a subsequent faster return to normal daily activities; nonetheless, LC has a higher incidence in bile duct injury as compared to open cholecystectomy. Nearly all studies report the incidence of bile duct injury following open cholecystectomy between 0.1% and 0.2%. In comparison, LC has a reported incidence of bile duct injury between 0.4% and 0.7%. The aim of this article is to review our initial experience with work-up and repair of bile duct injuries following LC performed at outside facilities and referred to the University of Mississippi Medical Center (UMMC) for definitive therapy. We will also review the classification of these injuries, preferred methods of diagnosis, and benefits of early treatment as well as factors that frequently lead to litigation following bile duct injury.
腹腔镜胆囊切除术后胆管损伤是胆囊切除术最令人担忧的并发症之一。对于胆管损伤患者，早期识别和修复可挽救生命。自20世纪90年代初以来，腹腔镜胆囊切除术（LC）已取代开腹胆囊切除术，成为有症状胆结石、胆囊运动障碍和胆囊炎的首选治疗方法。LC缩短了住院时间和术后疼痛，使患者能更快恢复正常日常活动；尽管如此，与开腹胆囊切除术相比，LC导致胆管损伤的发生率更高。几乎所有研究报告开腹胆囊切除术后胆管损伤的发生率在0.1%至0.2%之间。相比之下，LC报告的胆管损伤发生率在0.4%至0.7%之间。本文旨在回顾我们对在外部机构进行LC术后转诊至密西西比大学医学中心（UMMC）进行确定性治疗的胆管损伤患者进行检查和修复的初步经验。我们还将回顾这些损伤的分类、首选诊断方法、早期治疗的益处以及胆管损伤后经常导致诉讼的因素。
