Inui H, Kwon A H, Kamiyama Y
First Department of Surgery, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka 570-8507, Japan.
J Hepatobiliary Pancreat Surg. 1998;5(4):445-9. doi: 10.1007/s005340050070.
Laparoscopic cholecystectomy is now the treatment of choice for gallstones, but there has been concern that bile leakage after a laparoscopic cholecystectomy is more frequent than after an open cholecystectomy. We have experienced 16 patients with bile duct injury after a laparoscopic cholecystectomy. Five patients had a circumferential injury to the major bile duct, and we employed a converted open technique for biliary reconstruction. The other 11 patients had partial injury to the major bile duct, and we performed laparoscopic restoration; all 11 of these patients received endoscopic retrograde cholangiography (ERC) on the day after the operation and stenting for biliary decompression and drainage. No complications were identified and the duration of hospitalization in these patients was significantly shorter than in those who had the converted procedure. If intraoperative cholangiography is performed routinely, the presence and form of bile duct injury can be clearly identified, and the decision to restore the site of injury or to convert to the open technique for biliary reconstruction can be made immediately.
腹腔镜胆囊切除术现已成为治疗胆结石的首选方法，但有人担心腹腔镜胆囊切除术后胆漏比开腹胆囊切除术后更常见。我们遇到过16例腹腔镜胆囊切除术后胆管损伤的患者。5例患者主要胆管发生环形损伤，我们采用了转为开腹手术的技术进行胆管重建。另外11例患者主要胆管发生部分损伤，我们进行了腹腔镜修复；这11例患者均在术后第一天接受了内镜逆行胆管造影（ERC）并置入支架进行胆管减压和引流。未发现并发症，这些患者的住院时间明显短于接受转为开腹手术的患者。如果常规进行术中胆管造影，可以清楚地识别胆管损伤的存在和形式，并可立即决定修复损伤部位或转为开腹手术进行胆管重建。
