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Preventive measures for bile duct injury and bleeding during laparoscopic cholecystectomy
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摘要: 目的探讨在腹腔镜胆囊切除术（LC）中预防胆道损伤及出血的方法。方法回顾性分析2010年9月-2013年6月在西安市第十二医院行LC的600例患者的临床资料,并结合相关文献资料总结预防胆道损伤及出血的经验和方法。结果 600例患者中2例中转开腹,1例LC术后发生胆瘘;无远期并发症发生,所有患者均临床治愈出院,无1例死亡。结论重视胆囊三角区的钝性分离和精细解剖;强调胆囊颈部三维结构的分离、辨认;灵活、合理处理急性、亚急性胆囊炎患者胆管结构的解剖;根据术中情况决定胆囊壁的切除与保留,是预防LC术中胆管损伤及出血的关键。Abstract: Objective To investigate the surgical methods for the prevention of bile duct injury and bleeding during laparoscopic cholecystectomy( LC). Methods The clinical data of 600 patients who underwent LC from September 2010 to June 2013 were analyzed retrospectively,and with reference to related articles and data,the methods for the prevention of bile duct injury and bleeding were summarized.Results Among the 600 patients,2 were converted to open surgery and 1 experienced biliary fistula after LC. There were no long- term complications,and all the patients were cured and discharged,without deaths. Conclusion The key points in preventing bile duct injury and bleeding during LC are the attention to blunt dissection and fine anatomy of the Calot's triangle,the emphasis on the separation and identification of the three- dimensional structure of the neck of the gallbladder,a flexible and proper treatment of the anatomic structures of the bile duct in patients with acute or subacute cholecystitis,and a decision on the resection or preservation of the gallbladder wall,which is made according to the situation during surgery.
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Key words:
- cholecystectomy,laparoscopic /
- intraoperative complications /
- hemobilia
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[1]TUVERI M,CALO PG,MEDAS F,et al.Limits and advantanges of fundus-frist laparoscopic chotectomy:Lessons learned[J].J Laparoendosc Adv Suregy Tech A,2008,18(1):69-75. [2]YANG Q,FENG P,ZHANG ZB.Laparoscopic cholecystectomy:a clinical analysis of 130 cases[J].Jilin Med J,2011,32(11):2188-2189.(in Chinese)杨强,封平,张震波.腹腔镜胆囊切除术130例临床分析[J].吉林医学,2011,32(11):2188-2189. [3]LI PJ,JI ZL,SUN HY,et al.Experience of fine dissection in prevention of bile duct injury in laparoscopic cholecystectomy:an analysis of 9500 cases[J].Chin J Dig Endosc,2010,27(10):540-542.(in Chinese)李平军,嵇振岭,孙鸿源,等.精细解剖-分离技术预防腹腔镜胆囊切除术中胆管损伤9500例体会[J].中华消化内镜杂志,2010,27(10):540-542. [4]HUANG ZQ.Bile duct injury in the era of laparoscopic surgery[J].J Hepatobiliary Surg,1998,6(2):65-66.(in Chinese)黄志强.腹腔镜外科时代的胆管损伤问题[J].肝胆外科杂志,1998,6(2):65-66. [5]LIU Z,YAN DH,JIANG Y.Reasons for bile duct injury caused by laparoscopic cholecystectomy:an analysis of 14 cases[J].J Hepatopancreatobiliary Surg,2012,24(2):154-155.(in Chinese)刘志,严德辉,蒋勇.腹腔镜胆囊切除术致胆管损伤14例原因分析[J].肝胆胰外科杂志,2012,24(2):154-155. [6]WANG H,LUO JG,LIANG P,et al.Risk factors for bile duct injury in laparoscopic cholecystectomy and postoperative analysis[J].J Hepatopancreatobiliary Surg,2011,23(4):296-298.(in Chinese)王宏,罗建管,梁鹏,等.LC术胆管损伤的危险因素及术后分析[J].肝胆胰外科杂志,2011,23(4):296-298. [7]WANG JY,HE JP.A clinical analysis of bile duct injury in conventional open cholecystectomy[J].China J Prac Med,2011,38(11):94-95.(in Chinese)王加印,何建平.常规开腹胆囊切除术胆管损伤的临床分析[J].中国实用医刊,2011,38(11):94-95. [8]GIGER U,OUAISSI M,SCHMITZ SF,et al.Bile duct injury and use of cholangiography during laparoscopic cholecystectomy[J].Br J Surg,2011,98(3):391-396. -
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