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中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 450 -454. doi: 10.3877/cma.j.issn.2095-3232.2017.06.008

所属专题: 文献

临床研究

腹腔镜胆囊切除术致变异右后叶胆管损伤的预防与处理
王先法1,(), 钟欣1, 祝和攀1, 顾利虎1   
  1. 1. 650032 杭州,浙江大学附属邵逸夫医院普通外科
  • 收稿日期:2017-09-18 出版日期:2017-12-10
  • 通信作者: 王先法
  • 基金资助:
    浙江省医药卫生科技计划项目(2017ZD019)

Prevention and treatment for aberrant bile duct injury in right posterior lobe by laparoscopic cholecystectomy

Xianfa Wang1,(), Xin Zhong1, Hepan Zhu1, Lihu Gu1   

  1. 1. Department of General Surgery, Sir Run Run Shaw Hospital Affiliated to Zhejiang University, Hangzhou 650032, China
  • Received:2017-09-18 Published:2017-12-10
  • Corresponding author: Xianfa Wang
  • About author:
    Corresponding author: Wang Xianfa, Email:
引用本文:

王先法, 钟欣, 祝和攀, 顾利虎. 腹腔镜胆囊切除术致变异右后叶胆管损伤的预防与处理[J]. 中华肝脏外科手术学电子杂志, 2017, 06(06): 450-454.

Xianfa Wang, Xin Zhong, Hepan Zhu, Lihu Gu. Prevention and treatment for aberrant bile duct injury in right posterior lobe by laparoscopic cholecystectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(06): 450-454.

目的

探讨腹腔镜胆囊切除术(LC)致变异右后叶胆管损伤的预防与处理。

方法

回顾性分析2010年1月至2014年12月浙江大学附属邵逸夫医院收治的4例LC所致变异右后叶胆管损伤患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男1例,女3例;年龄27~48岁,中位年龄39岁。根据Strasberg分型,变异右后叶胆管损伤类型均为C型。例1、2患者LC术中发现,例1中转开腹行右后叶胆管-空肠吻合,例2行胆管端端吻合T管引流。例3患者LC术后3 d发现,行右后叶胆管外引流。例4患者LC术后1 d发现,行内镜下逆行胆管造影鼻胆管引流。

结果

例1术后恢复顺利。例2术后8个月MRCP提示远端胆管扩张,再次行右后叶胆管-空肠吻合。第2次术后随访未出现胆漏、肝功能异常、胆管狭窄及胆管炎等情况。例3术后6个月给予拔除腹腔引流管。例4术后4个月给予拔除鼻胆管及腹腔引流管。截止至投稿日期4例均未出现胆漏、肝功能异常、胆管狭窄等情况。

结论

变异右后叶胆管损伤因胆管细小、损伤位置高,处理较困难,早期发现及早期修补是良好预后的关键,可根据损伤类型及确诊时间采用多种处理方法。

Objective

To investigate the prevention and treatment for aberrant bile duct injury in right posterior lobe by laparoscopic cholecystectomy (LC).

Methods

Clinical data of 4 patients with aberrant bile duct injury in right posterior lobe caused by LC who were admitted to the Sir Run Run Shaw Hospital Affiliated to Zhejiang University between January 2010 and December 2014 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 case was male and 3 were female, aged 27-48 years old with a median age of 39 years old. According to Strasberg classification, the types of aberrant bile duct injury in right posterior lobe were all type C. Aberrant bile duct injury in right posterior lobe was found in case 1 and 2 during LC, case 1 was converted to receive right posterior lobe cholangiojejunostomy by laparotomy, and case 2 received end-to-end biliary anastomosis with T tube drainage. It was found in case 3 3 d after LC, and case 3 received right posterior bile duct drainage. It was found in case 4 1 d after LC, and case 4 received endoscopic retrograde cholangiography naso-biliary drainage.

Results

Case 1 recovered well after operation. Case 2 was observed with distal bile duct dilatation by MRCP at postoperative 8 months, and received right posterior lobe cholangiojejunostomy again. No biliary leakage, abnormal liver function, bile duct stenosis and cholangitis was observed during the follow-up after the second operation. For case 3, abdominal drainage tube was removed at postoperative 6 months. For case 4, naso-biliary tube and abdominal drainage tube were removed at postoperative 4 months. No bile leakage, abnormal liver function and bile duct stenosis was observed in 4 cases till the submission date.

Conclusions

It is difficult to treat the aberrant bile duct injury in right posterior lobe due to small bile duct and high position of injury. Early detection and early repair are the keys to good prognosis, and a variety of treatment methods can be used according to the types of injury and time of definite diagnosis.

图1 Strasberg胆道损伤分型及腹腔镜胆囊切除术变异右后叶胆管损伤患者影像学检查
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