中国实用外科杂志

中国实用外科杂志

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腹腔镜胆囊切除术中Rouviere沟解剖定位及其应用价值研究

蔡华杰，叶百亮，韩    宇，暨    玲，屠金夫，郑晓风，蒋飞照   

  1. 温州医学院附属第一医院腔镜外科，浙江温州325003
  • 发布日期:2012-02-24

  • Published:2012-02-24

摘要：

目的    探讨Rouviere沟作为肝外胆管参照点在腹腔镜胆囊切除术中的作用。 方法    自2010年3月至2011年4月温州医学院附属第一医院腔镜外科连续实施腹腔镜胆囊切除术584例，术中记录Rouviere沟的出现率及分型，并采用以Rouviere沟为导向的胆囊三角区解剖方法。 结果    584例中，开放型Rouviere沟346例，融合型Rouviere沟102例，共448例（76.7%）存在Rouviere沟。全组未发生胆管损伤及手术死亡，3例（0.5%）中转开腹，所有病例恢复良好。 结论    Rouviere沟是重要的肝外胆管解剖标志，出现于大多数人中。以Rouviere沟为导向的胆囊三角区解剖方法可以预防腹腔镜胆囊切除术中胆管损伤，值得推广应用。

关键词: 胆管损伤, 腹腔镜胆囊切除术, Rouviere沟

Abstract:

Role of Rouviere's sulcus as anatomic landmark in laparoscopic cholecystectomy        CAI Hua-jie，YE Bai-liang, HAN Yu, et al. Department of Endoscopic Surgery，the First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325003, China
Corresponding author：HAN Yu, E-mail: tongji99@sina.com
Abstract    Objective    To explore the role of Rouviere's sulcus as extrabiliary reference point in laparoscopic cholecystectomy. Methods    The clinical data of 584 patients performed laparoscopic cholecystectomy from March 2010 to April 2011 in the Department of Endoscopic Surgery，the First Affiliated Hospital of Wenzhou Medical College were analyzed. Frequency and type of Rouviere's sulcus were documented and Rouviere's sulcus was used to guide the commencement of dissection in hepatobiliary triangle in laparoscopic cholecystectomy. Results    A total of 584 patients who underwent laparoscopic cholecystectomy were included in the study. Open type of Rouviere's sulcus was visualized in 346 patients and fused type of Rouviere's sulcus was visualized in 102 patients. Hence in a total of 448 (76.7%) patients had Rouviere's sulcus. There was no bile duct injury or mortality. Three patients were converted to open operation (0.5%) and all patients recovered well. Conclusion    Rouviere's sulcus is an important extrabiliary landmark and identifiable in majority of patients. Its identification before commencement of Calot’s triangle dissection may help in preventing the bile duct injury in laparoscopic cholecystectomy and should be applied widely.

Key words: bile duct injury, laparoscopic cholecystectomy, Rouviere's sulcus