Sekimoto M, Tomita N, Tamura S, Ohsato H, Monden M
Department of Surgery II, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565, Japan.
Surg Endosc. 1998 Dec;12(12):1439-41. doi: 10.1007/s004649900877.
Bile duct injuries during laparoscopic cholecystectomy (LC) are thought to occur because surgeons tend to confuse the common bile duct (CBD) with the cystic duct. Among reasons for this misidentification, the difference in the way the operating field is exposed in LC compared to open cholecystectomy should be noticed. Using Dr. Reddick's technique, which is commonly practiced, the upward and the lateral traction of the gallbladder results in a narrower Calot's triangle and angulation of the CBD. These anatomical distortions are thought to contribute to ductal injuries during LC.
We propose a new method to expose Calot's triangle during LC. The principle of this technique is to expose the hepatic hilus by retracting the caudal surfaces of the quadrate and lateral lobes of the liver using an atraumatic curved instrument.
The advantages of this technique are that one gains wide exposure of the hepatic hilus, leaves Calot's triangle undistorted, and avoids tenting the CBD.
This new technique may make LC safer and decrease the number of bile duct injuries associated with the misidentification of the anatomy.
腹腔镜胆囊切除术（LC）期间的胆管损伤被认为是由于外科医生倾向于将胆总管（CBD）与胆囊管混淆所致。在这种错误识别的原因中，应注意到与开腹胆囊切除术相比，LC中手术视野暴露方式的差异。采用常用的雷迪克医生技术，向上和侧向牵拉胆囊会导致胆囊三角变窄以及胆总管成角。这些解剖结构的改变被认为是导致LC期间胆管损伤的原因。
我们提出一种在LC期间暴露胆囊三角的新方法。该技术的原理是使用无创伤的弯曲器械牵拉肝脏方叶和外侧叶的尾状表面来暴露肝门。
该技术的优点是能广泛暴露肝门，使胆囊三角保持不变形，并避免胆总管成角。
这种新技术可能会使LC更安全，并减少与解剖结构错误识别相关的胆管损伤数量。
