The Analysis and Prevention of Bile Duct Injury Due to Laparoscopic Cholecystectomy_West China Medical Journal

Authors：

 LIUYong , YANLei , LIANGGuang-xi , HUANGCheng-jun , NIBang-gao

Department of General Surgery, the People's Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

Keywords：

Bile duct injury; Laparoscopic cholecystectomy; Cause; Prevention

DOI：

10.7507/1002-0179.20150578

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Objective To explore the causes of bile duct injury due to laparoscopic cholecystectomy (LC) and the preventive methods. Methods A total of 18 patients with bile duct injury (with the occurrence rate of 0.4%) after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old[averaging (42.3±3.6) years old]. The clinical data of the patients were retrospectively analyzed. Results In the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome withⅠ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. Conclusion The operator's experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.

Citation： LIUYong, YANLei, LIANGGuang-xi, HUANGCheng-jun, NIBang-gao. The Analysis and Prevention of Bile Duct Injury Due to Laparoscopic Cholecystectomy. West China Medical Journal, 2015, 30(11): 2027-2030. doi: 10.7507/1002-0179.20150578 Copy

1.	中華醫學會外科學分會膽道外科學組. 膽管損傷的診斷和治療指南[J]. 中華消化外科雜志, 2013, 12(2):81-95.
2.	Strasberg SM, Hertl M, Soper NJ. Analysis of the problem of biliary injury during laparoscopic cholecystectomy[J]. J Am Coll Surg, 1995, 180:101-105.
3.	陳祖兵, 沈世強, 丁佑銘, 等. 膽囊切除術膽道損傷20例的Strasberg分型、處理與預后[J]. 腹部外科, 2010, 23(6):346-347.
4.	Archer SB, Brown DW, Smith CD, et al. Bile duct injury during laparoscopic cholecystectomy:results of a national survry[J]. Ann Surg, 2001, 234(4):549-559.
5.	王秋虹, 田大廣, 胡明道, 等. 腹腔鏡膽囊切除術所致膽道損傷因素及防治[J]. 中國誤診學雜志, 2012, 10(12):2790-2792.
6.	王明亮, 蔣渝, 董峰, 等. 腹腔鏡膽囊切除術中右肝管分支損傷的預防和治療(附7例分析)[J]. 外科理論與實踐, 2005, 10(4):320-322, 328.
7.	劉學禮, 程平, 劉安成, 等. 急性膽囊炎腹腔鏡膽囊切除術67例體會[J]. 腹部外科, 2012, 25(6):389-390.
8.	巨邦律, 于聰慧, 余昌中, 等. 磁共振胰膽管成像在腹腔鏡膽囊切除術中的意義[J]. 中華肝膽外科雜志, 2011, 17(2):155-156.
9.	李為民, 蕭蔭祺, 劉浩潤, 等. Mirizzi綜合征與腹腔鏡膽囊切除術中的膽管損傷[J]. 中華肝膽外科雜志, 2004, 10(2):140-141.
10.	靳懷安, 周振理. Mirizzi綜合征的診治方法探討[J]. 中華全科醫學, 2013, 11(6):892, 914.
11.	巨邦律, 于聰慧, 余昌中, 等. 腹腔鏡膽囊切除術壺腹入路法537例臨床總結[J]. 中國實用外科雜志, 2012, 32(2):145-146.
12.	李平軍, 嵇振嶺, 孫鴻源, 等. “推拉牽引-放松歸位-反復確認”技術在腹腔鏡膽囊切除術中預防膽道損傷的臨床價值[J]. 中華肝膽外科雜志, 2011, 17(2):102-103.
13.	楊浩雷, 保紅平, 姚永良, 等. 腹腔鏡順逆結合膽囊切除術預防膽管損傷的臨床分析[J]. 中國普通外科雜志, 2006, 15(8):576-578.
14.	蔡秀軍, 顧曉靜, 王一帆, 等. 沖吸鈍性解剖法顯露肝總管防止腹腔鏡膽囊切除術中膽道損傷[J]. 中華醫學雜志, 2007, 87(20):1425-1426.
15.	李良, 張軍, 趙煒, 等. 腹腔鏡膽囊切除術中膽道損傷的危險因素分析[J]. 中華全科醫學, 2011, 9(7):1037-1039.

1. 中華醫學會外科學分會膽道外科學組. 膽管損傷的診斷和治療指南[J]. 中華消化外科雜志, 2013, 12(2):81-95.
2. Strasberg SM, Hertl M, Soper NJ. Analysis of the problem of biliary injury during laparoscopic cholecystectomy[J]. J Am Coll Surg, 1995, 180:101-105.
3. 陳祖兵, 沈世強, 丁佑銘, 等. 膽囊切除術膽道損傷20例的Strasberg分型、處理與預后[J]. 腹部外科, 2010, 23(6):346-347.
4. Archer SB, Brown DW, Smith CD, et al. Bile duct injury during laparoscopic cholecystectomy:results of a national survry[J]. Ann Surg, 2001, 234(4):549-559.
5. 王秋虹, 田大廣, 胡明道, 等. 腹腔鏡膽囊切除術所致膽道損傷因素及防治[J]. 中國誤診學雜志, 2012, 10(12):2790-2792.
6. 王明亮, 蔣渝, 董峰, 等. 腹腔鏡膽囊切除術中右肝管分支損傷的預防和治療(附7例分析)[J]. 外科理論與實踐, 2005, 10(4):320-322, 328.
7. 劉學禮, 程平, 劉安成, 等. 急性膽囊炎腹腔鏡膽囊切除術67例體會[J]. 腹部外科, 2012, 25(6):389-390.
8. 巨邦律, 于聰慧, 余昌中, 等. 磁共振胰膽管成像在腹腔鏡膽囊切除術中的意義[J]. 中華肝膽外科雜志, 2011, 17(2):155-156.
9. 李為民, 蕭蔭祺, 劉浩潤, 等. Mirizzi綜合征與腹腔鏡膽囊切除術中的膽管損傷[J]. 中華肝膽外科雜志, 2004, 10(2):140-141.
10. 靳懷安, 周振理. Mirizzi綜合征的診治方法探討[J]. 中華全科醫學, 2013, 11(6):892, 914.
11. 巨邦律, 于聰慧, 余昌中, 等. 腹腔鏡膽囊切除術壺腹入路法537例臨床總結[J]. 中國實用外科雜志, 2012, 32(2):145-146.
12. 李平軍, 嵇振嶺, 孫鴻源, 等. “推拉牽引-放松歸位-反復確認”技術在腹腔鏡膽囊切除術中預防膽道損傷的臨床價值[J]. 中華肝膽外科雜志, 2011, 17(2):102-103.
13. 楊浩雷, 保紅平, 姚永良, 等. 腹腔鏡順逆結合膽囊切除術預防膽管損傷的臨床分析[J]. 中國普通外科雜志, 2006, 15(8):576-578.
14. 蔡秀軍, 顧曉靜, 王一帆, 等. 沖吸鈍性解剖法顯露肝總管防止腹腔鏡膽囊切除術中膽道損傷[J]. 中華醫學雜志, 2007, 87(20):1425-1426.
15. 李良, 張軍, 趙煒, 等. 腹腔鏡膽囊切除術中膽道損傷的危險因素分析[J]. 中華全科醫學, 2011, 9(7):1037-1039.

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The Analysis and Prevention of Bile Duct Injury Due to Laparoscopic Cholecystectomy

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