探讨腹腔镜胆囊切除术胆管损伤的外科处理效果。

北京大学第一医院普通外科2001年1月至2017年12月行3695例腹腔镜胆囊切除术，发生胆管损伤11例（0.3%）。胆管部分损伤5例，行缝合修复，其中4例放置T管引流；胆管横断伤6例，行胆管端端吻合T管引流3例，行预置盲襻式胆管空肠Roux-en-Y吻合3例。

7例T管引流于术后6~12个月拔除。11例随访时间18~60个月，平均44.8个月。胆肠吻合口狭窄2例，行胆道镜球囊扩张；余9例未出现胆管狭窄。

胆管缝合修复、胆管端端吻合、预置盲襻式胆管空肠Roux-en-Y吻合均是胆管损伤后外科处理的有效手段；胆管损伤修复后出现胆管狭窄，可以选择胆道镜球囊扩张，必要时行再手术矫正。

To explore the surgical management for bile duct injury during laparoscopic cholecystectomy.

From January 2001 to December 2017, 3695 cases of laparoscopic cholecystectomy were performed at the Department of Surgery, Peking University First Hospital, of which 11 (0.3%) suffered from bile duct injury. Five cases of non-transected bile duct injury underwent suture repair, and T-tube drainage was placed in four cases. Six cases of bile duct transection injury were treated either by end-to-end biliary anastomosis with T-tube drainage (n=3) or by Roux-en-Y choledochojejunostomy (n=3).

T-tubes in seven patients were removed 6~12 months after operation. The 11 patients with bile duct injury were followed for 18~60 months, with an average of 44.8 months. Balloon dilatation under a choledochoscope was performed in two cases of anastomotic stricture of the bile duct and jejunum, and no biliary stricture was found in the remaining nine cases.

Suture repair of the bile duct, end-to-end biliary anastomosis, and roux-en-Y choledochojejunostomy are all effective means for surgical treatment of bile duct injury. Balloon dilatation under a choledochoscope can be selected for bile duct stenosis after repair of bile duct injury, and reoperation can be performed if necessary.