中国实用外科杂志

中国实用外科杂志

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胆道外科的永恒议题——胆囊切除术胆管损伤的预防

董家鸿，曾建平   

  1. 北京清华长庚医院肝胆胰中心，北京102218
  • 出版日期:2015-09-01 发布日期:2015-08-28

  • Online:2015-09-01 Published:2015-08-28

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摘要：

胆囊切除术是造成医源性胆管损伤最常见的因素，损伤机制复杂多样。损伤最直接的原因多来源于对胆管走行的错误辨识，但学习曲线、不熟练的操作、缺乏经验、盲目自信、疾病的病理状态、胆道的解剖变异、手术器械的限制等均是可能造成此类错误和胆管损伤的潜在因素。预防胆管损伤的发生涉及腹腔镜和胆囊切除术的专业培训，外科医师经验的积累和对胆管损伤的警惕心态，手术适应证和手术方式的正确选择，外科医师对自身手术能力、胆囊切除术复杂程度和当时医疗条件的准确判断，胆囊切除技术的优化和手术器械的改进等。

关键词: 胆囊切除术, 胆管损伤

Abstract:

The eternal question of biliary surgery: Prevention of bile duct injury during laparoscopic cholecystectomy                        DONG Jia-hong，ZENG Jian-ping. Department of Hepato-biliary-pancreatic Surgery，Beijing Tsinghua Changgung Hospital，Medical Center，Tsinghua University，Beijing 102218, China
Corresponding author：DONG Jia-hong，E-mail：Dongjh301@163.com
Abstract    Cholecystectomy is the most common leading cause of iatrogenic injury of bile duct. The potential reasons for the injury could be complicated，mostly due to failure identifying the biliary structures，and also includes other possibilities such as learning curve，lacking experiences，overconfident，pathological states of diseases，biliary anatomical variations，limited conditions of surgical instruments and so on. The strategies for preventing the bile duct injuries include professional training，accumulated experiences，vigilance of bile duct injuries，rational evaluation of surgical skills，skilled techniques in operation，accurately judgment of difficulties during operation and limitation of medical conditions. In conclusion，proper attitude towards the risk of cholecystectomy is the primary factor of preventing bile duct injuries.

Key words: cholecystectomy, bile duct injury