Prevention and Treatment of Bile Duct Injury in Laparoscopic Cholecystectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PAN Guangdong , CHENG Nansheng

Department of General Surgery, West China Hospital, Sichuan University， Chengdu 610041, China;

Corresponding author：

Keywords：

Laparoscopic cholecystectomyBile duct injuryPreventionTreatment

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Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.

Citation： PAN Guangdong,CHENG Nansheng. Prevention and Treatment of Bile Duct Injury in Laparoscopic Cholecystectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2004, 11(3): 211-227. doi: Copy

1.	Deziel DJ, Millikan KW, Economou SG, et al. Complication of laparoscopic cholecystectomy: a national survey of 4 296 hospitals and an analysis of 7 7604 cases 　[J]. Am J Surg, 1993; 165（1）∶9.
2.	McMahon AJ, Fullarton G, Baxter JN, et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy 　[J]. Br J Surg, 1995; 82（3）∶307.
3.	Shea JA, Healey MJ, Berlin JA, et al. Mortality and complications associated with laparoscopic cholecystectomy. A metaanalysis 　[J]. Ann Surg, 1996; 224（5）∶609.
4.	王平. 腹腔镜胆囊切除术中胆管损伤的防治进展　[J]. 中华肝胆外科杂志，1999; 5(4)∶282.
5.	舒晔,周总光,解蓉，等. 腹腔镜胆囊切除术细小胆管损伤的诊断与处理　[J]. 中国普外基础与临床杂志， 2001； 8(2)∶88.
6.	彭文勋，王克成，邓明福，等. 腹腔镜胆囊切除10518例报告　[J]. 腹腔镜外科杂志, 1999； 4(1)∶1.
7.	王广义，谭毓铨. 医源性胆管损伤的防治进展　[J]. 中国实用外科杂志， 1999； 19（6）∶497.
8.	吴金术, 毛先海，廖春红，等. 101例医源性胆道损伤的临床分析　[J]. 中华肝胆外科杂志, 2001； 7(10)∶606.
9.	陆伟，师天雄，常晓健，等. 电视腹腔镜胆囊切除术31例并发症的临床处理体会　[J]. 肝胆外科杂志， 2001； 9(3)∶202.
10.	罗丁，陈训如，李胜宏，等. 类Mirizzi综合征腹腔镜胆囊切除的一种高危解剖　[J]. 中华肝胆外科杂志, 2001； 7(10)∶628.
11.	毛静熙，陈训如，罗丁，等. 腹腔镜切除左位胆囊17例　[J]. 中华普通外科杂志, 2001； 16(6)∶382.
12.	朱瑜，张德全，金龙标. 腹腔镜胆囊切除胆管损伤5例　[J]. 中华肝胆外科杂志, 2001; 7（12）∶725.
13.	郑朝纪，何小东，肖毅，等. 腹腔镜胆囊切除术的经验与体会　[J]. 中华肝胆外科杂志, 2001; 7(7)∶436.
14.	郑成竹. 腹腔镜胆囊切除术常见并发症分析及预防　[J]. 肝胆胰外科杂志, 2001; 13(1)∶3.
15.	林擎天. 胆囊切除术中胆管损伤的防治　[J]. 肝胆胰外科杂志, 2001； 13(1)∶1.
16.	Vezakis A， Davides D， Ammori BJ， et al. Intraoperative cholangiography during laparoscopic cholecystectomy [J]. Surg Endosc, 2000; 14(12)∶1118.
17.	Ladocsi LT, Benitez LD, Filippone DR. Intraoperative cholangiography in laparoscopic cholecystectomy： a review of 734 consecutive cases 　[J]. Am Surg, 1997; 63(2)∶150.
18.	王红军, 韩朝阳, 乔祖俊. 腹腔镜超声检查在胆囊切除胆道探查术中的应用　[J]. 肝胆外科杂志， 2001; 9(2)∶110.
19.	Mathur SK, Soonawalla ZF, Shah SR, et al. Role of biliary scintiscan in predicting the need for cholangiography 　[J]. Br J Surg, 2000; 87(2)∶181.
20.	Nishiguchi S， Shiomi S， Sasaki N， et al. A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: value of scintigraphy with Tc99m GSA and hepatobiliary scintigraphy for indication of lobectomy 　[J]. Ann Nucl Med, 2000； 14(5)∶383.
21.	罗丁, 陈训如, 李胜宏，等. 腹腔镜胆囊切除术并发胆道损伤的术中非影像诊断　[J]. 中华肝胆外科杂志， 2001; 7（7）∶435.
22.	王先法, 虞洪, 蔡秀灵，等. 腹腔镜胆囊切除术致胆管损伤的特点、处理及预防方法　[J]. 中华肝胆外科杂志, 2001; 7（10）∶609.
23.	任为. 胆管损伤与胆管狭窄的临床治疗进展　[J]. 中华肝胆外科杂志, 2001; 7（2）∶126.

1. Deziel DJ, Millikan KW, Economou SG, et al. Complication of laparoscopic cholecystectomy: a national survey of 4 296 hospitals and an analysis of 7 7604 cases 　[J]. Am J Surg, 1993; 165（1）∶9.
2. McMahon AJ, Fullarton G, Baxter JN, et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy 　[J]. Br J Surg, 1995; 82（3）∶307.
3. Shea JA, Healey MJ, Berlin JA, et al. Mortality and complications associated with laparoscopic cholecystectomy. A metaanalysis 　[J]. Ann Surg, 1996; 224（5）∶609.
4. 王平. 腹腔镜胆囊切除术中胆管损伤的防治进展　[J]. 中华肝胆外科杂志，1999; 5(4)∶282.
5. 舒晔,周总光,解蓉，等. 腹腔镜胆囊切除术细小胆管损伤的诊断与处理　[J]. 中国普外基础与临床杂志， 2001； 8(2)∶88.
6. 彭文勋，王克成，邓明福，等. 腹腔镜胆囊切除10518例报告　[J]. 腹腔镜外科杂志, 1999； 4(1)∶1.
7. 王广义，谭毓铨. 医源性胆管损伤的防治进展　[J]. 中国实用外科杂志， 1999； 19（6）∶497.
8. 吴金术, 毛先海，廖春红，等. 101例医源性胆道损伤的临床分析　[J]. 中华肝胆外科杂志, 2001； 7(10)∶606.
9. 陆伟，师天雄，常晓健，等. 电视腹腔镜胆囊切除术31例并发症的临床处理体会　[J]. 肝胆外科杂志， 2001； 9(3)∶202.
10. 罗丁，陈训如，李胜宏，等. 类Mirizzi综合征腹腔镜胆囊切除的一种高危解剖　[J]. 中华肝胆外科杂志, 2001； 7(10)∶628.
11. 毛静熙，陈训如，罗丁，等. 腹腔镜切除左位胆囊17例　[J]. 中华普通外科杂志, 2001； 16(6)∶382.
12. 朱瑜，张德全，金龙标. 腹腔镜胆囊切除胆管损伤5例　[J]. 中华肝胆外科杂志, 2001; 7（12）∶725.
13. 郑朝纪，何小东，肖毅，等. 腹腔镜胆囊切除术的经验与体会　[J]. 中华肝胆外科杂志, 2001; 7(7)∶436.
14. 郑成竹. 腹腔镜胆囊切除术常见并发症分析及预防　[J]. 肝胆胰外科杂志, 2001; 13(1)∶3.
15. 林擎天. 胆囊切除术中胆管损伤的防治　[J]. 肝胆胰外科杂志, 2001； 13(1)∶1.
16. Vezakis A， Davides D， Ammori BJ， et al. Intraoperative cholangiography during laparoscopic cholecystectomy [J]. Surg Endosc, 2000; 14(12)∶1118.
17. Ladocsi LT, Benitez LD, Filippone DR. Intraoperative cholangiography in laparoscopic cholecystectomy： a review of 734 consecutive cases 　[J]. Am Surg, 1997; 63(2)∶150.
18. 王红军, 韩朝阳, 乔祖俊. 腹腔镜超声检查在胆囊切除胆道探查术中的应用　[J]. 肝胆外科杂志， 2001; 9(2)∶110.
19. Mathur SK, Soonawalla ZF, Shah SR, et al. Role of biliary scintiscan in predicting the need for cholangiography 　[J]. Br J Surg, 2000; 87(2)∶181.
20. Nishiguchi S， Shiomi S， Sasaki N， et al. A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: value of scintigraphy with Tc99m GSA and hepatobiliary scintigraphy for indication of lobectomy 　[J]. Ann Nucl Med, 2000； 14(5)∶383.
21. 罗丁, 陈训如, 李胜宏，等. 腹腔镜胆囊切除术并发胆道损伤的术中非影像诊断　[J]. 中华肝胆外科杂志， 2001; 7（7）∶435.
22. 王先法, 虞洪, 蔡秀灵，等. 腹腔镜胆囊切除术致胆管损伤的特点、处理及预防方法　[J]. 中华肝胆外科杂志, 2001; 7（10）∶609.
23. 任为. 胆管损伤与胆管狭窄的临床治疗进展　[J]. 中华肝胆外科杂志, 2001; 7（2）∶126.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prevention and Treatment of Bile Duct Injury in Laparoscopic Cholecystectomy

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