摘要

从1990年1月至1994年6月，53名在腹腔镜胆囊切除术中胆管损伤的病人在阿姆斯特丹学术医疗中心接受治疗。其中男性16人，女性37人，平均年龄47岁。对所有患者进行中位17个月的随访。我们确定了四种类型的导管损伤。A型(18例)为胆囊管或周围肝根渗漏，B型(11例)为胆管主要渗漏，C型(9例)为孤立性胆管狭窄，D型(15例)为胆管完全横断。内镜逆行胰胆管造影(ERCP)对所有A型、B型和C型病变均有诊断。在D型病变中，需要经皮胆管造影来圈定损伤的近端范围。最初的治疗(直到症状消失和出院)包括36例患者的内窥镜检查和26例患者的手术。在18例A型病变中有16例，7例B型病变中有5例，9例C型病变中有3例可以进行内镜治疗并取得成功。大多数失败的原因是在最初的内窥镜检查时无法通过狭窄或泄漏。 During initial treatment additional surgery was required in seven patients. Fourteen patients underwent percutaneous or surgical drainage of bile collections, or both. After endoscopic treatment early complications occurred in three patients, with a fatal outcome in two (not related to the endoscopic therapy). During follow up six patients developed late complications. All 15 patients with complete transection and four patients with major bile duct leakage were initially treated surgically. During initial treatment additional endoscopy was required in two patients. Early complications occurred in eight patients. During follow up seven patients developed stenosis of the anastomosis or bile duct. Reconstructive surgery in the early postoperative phase was associated with more complications than elective reconstructive surgery. Most type A and B bile duct injuries after laparoscopic cholecystectomy (80%) can be treated endoscopically. In patients with more severe ductal injury (type C and D) reconstructive surgery is eventually required in 70%. Multidisciplinary approach to these lesions is advocated and algorithms for treatment are proposed.