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.	中华医学会外科学分会胆道外科学组. 胆管损伤的诊断和治疗指南[J]. 中华消化外科杂志, 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.	陈祖兵, 沈世强, 丁佑铭, 等. 胆囊切除术胆道损伤20例的Strasberg分型、处理与预后[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, 田大广, 胡明道, 等. 腹腔镜胆囊切除术所致胆道损伤因素及防治[J]. 中国误诊学杂志, 2012, 10(12):2790-2792.
6.	王明亮, 蒋渝, 董峰, 等. 腹腔镜胆囊切除术中右肝管分支损伤的预防和治疗(附7例分析)[J]. 外科理论与实践, 2005, 10(4):320-322, 328.
7.	刘学礼, 程平, 刘安成, 等. 急性胆囊炎腹腔镜胆囊切除术67例体会[J]. 腹部外科, 2012, 25(6):389-390.
8.	巨邦律, 于聪慧, 余昌中, 等. 磁共振胰胆管成像在腹腔镜胆囊切除术中的意义[J]. 中华肝胆外科杂志, 2011, 17(2):155-156.
9.	李为民, 萧荫祺, 刘浩润, 等. Mirizzi综合征与腹腔镜胆囊切除术中的胆管损伤[J]. 中华肝胆外科杂志, 2004, 10(2):140-141.
10.	靳怀安, 周振理. Mirizzi综合征的诊治方法探讨[J]. 中华全科医学, 2013, 11(6):892, 914.
11.	巨邦律, 于聪慧, 余昌中, 等. 腹腔镜胆囊切除术壶腹入路法537例临床总结[J]. 中国实用外科杂志, 2012, 32(2):145-146.
12.	李平军, 嵇振岭, 孙鸿源, 等. “推拉牵引-放松归位-反复确认”技术在腹腔镜胆囊切除术中预防胆道损伤的临床价值[J]. 中华肝胆外科杂志, 2011, 17(2):102-103.
13.	杨浩雷, 保红平, 姚永良, 等. 腹腔镜顺逆结合胆囊切除术预防胆管损伤的临床分析[J]. 中国普通外科杂志, 2006, 15(8):576-578.
14.	蔡秀军, 顾晓静, 王一帆, 等. 冲吸钝性解剖法显露肝总管防止腹腔镜胆囊切除术中胆道损伤[J]. 中华医学杂志, 2007, 87(20):1425-1426.
15.	李良, 张军, 赵炜, 等. 腹腔镜胆囊切除术中胆道损伤的危险因素分析[J]. 中华全科医学, 2011, 9(7):1037-1039.

1. 中华医学会外科学分会胆道外科学组. 胆管损伤的诊断和治疗指南[J]. 中华消化外科杂志, 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. 陈祖兵, 沈世强, 丁佑铭, 等. 胆囊切除术胆道损伤20例的Strasberg分型、处理与预后[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, 田大广, 胡明道, 等. 腹腔镜胆囊切除术所致胆道损伤因素及防治[J]. 中国误诊学杂志, 2012, 10(12):2790-2792.
6. 王明亮, 蒋渝, 董峰, 等. 腹腔镜胆囊切除术中右肝管分支损伤的预防和治疗(附7例分析)[J]. 外科理论与实践, 2005, 10(4):320-322, 328.
7. 刘学礼, 程平, 刘安成, 等. 急性胆囊炎腹腔镜胆囊切除术67例体会[J]. 腹部外科, 2012, 25(6):389-390.
8. 巨邦律, 于聪慧, 余昌中, 等. 磁共振胰胆管成像在腹腔镜胆囊切除术中的意义[J]. 中华肝胆外科杂志, 2011, 17(2):155-156.
9. 李为民, 萧荫祺, 刘浩润, 等. Mirizzi综合征与腹腔镜胆囊切除术中的胆管损伤[J]. 中华肝胆外科杂志, 2004, 10(2):140-141.
10. 靳怀安, 周振理. Mirizzi综合征的诊治方法探讨[J]. 中华全科医学, 2013, 11(6):892, 914.
11. 巨邦律, 于聪慧, 余昌中, 等. 腹腔镜胆囊切除术壶腹入路法537例临床总结[J]. 中国实用外科杂志, 2012, 32(2):145-146.
12. 李平军, 嵇振岭, 孙鸿源, 等. “推拉牵引-放松归位-反复确认”技术在腹腔镜胆囊切除术中预防胆道损伤的临床价值[J]. 中华肝胆外科杂志, 2011, 17(2):102-103.
13. 杨浩雷, 保红平, 姚永良, 等. 腹腔镜顺逆结合胆囊切除术预防胆管损伤的临床分析[J]. 中国普通外科杂志, 2006, 15(8):576-578.
14. 蔡秀军, 顾晓静, 王一帆, 等. 冲吸钝性解剖法显露肝总管防止腹腔镜胆囊切除术中胆道损伤[J]. 中华医学杂志, 2007, 87(20):1425-1426.
15. 李良, 张军, 赵炜, 等. 腹腔镜胆囊切除术中胆道损伤的危险因素分析[J]. 中华全科医学, 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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