Kurose M, Hamazaki K, Matsuoka J, Takai K, Kaneshige T, Moreira L F, Mimura H, Orita K
Okayama Central Hospital, Japan.
Acta Med Okayama. 1993 Oct;47(5):351-3. doi: 10.18926/AMO/31585.
Bile duct injury can occur more frequently during laparoscopic cholecystectomy than in open cholecystectomy. Three cases of common bile or hepatic duct injuries occurred in a series of eighty laparoscopic cholecystectomies; In case 1, the common bile duct was misidentified as the cystic duct. In case 2, bile peritonitis occurred on the fourth postoperative day caused by necrosis of the common hepatic duct involving the cautery surrounding it. In case 3, a bile leak occurred due to an incision at the confluence of the cystic and common duct. Dissection of the cystic duct at the infundibulum of the gallbladder, blunt dissection of the Calot's triangle, the handling of clips with special attention for safety were thought to be necessary in order to lower the risk of bile duct injury. Preoperative endoscopic retrograde cholangiography (ERCP) is recommended to avoid bile duct injury.
与开腹胆囊切除术相比，胆管损伤在腹腔镜胆囊切除术中的发生率可能更高。在一系列80例腹腔镜胆囊切除术中发生了3例胆总管或肝管损伤；病例1中，胆总管被误认作胆囊管。病例2中，术后第4天发生胆汁性腹膜炎，原因是肝总管坏死并累及周围的烧灼处。病例3中，由于胆囊管与胆总管汇合处的切口导致胆汁漏。为降低胆管损伤风险，认为在胆囊漏斗部解剖胆囊管、钝性解剖胆囊三角、特别注意夹子的安全操作是必要的。建议术前进行内镜逆行胰胆管造影（ERCP）以避免胆管损伤。
