Surgical management of bile duct injury during laparoscopic cholecystectomy

doi:10.3877/cma.j.issn.1674-0785.2022.04.003

Abstract

Abstract:

Objective

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

Methods

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).

Results

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.

Conclusion

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.

Key words: Cholecystectomy, Bile duct injury, Bile duct stenosis

Jirong Shi, Junguang Liu, Huan Zhang. Surgical management of bile duct injury during laparoscopic cholecystectomy[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(04): 304-307.

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References 10

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病例	性别	年龄（岁）	手术年月	胆管损伤情况	处理	随访及并发症	并发症的处理
1	女	45	2001年9月	术中发现胆总管横断，胆管缺损至左、右肝管水平	左、右肝管融合，预置盲襻式胆管空肠Roux-en-Y吻合	术后1年，胆肠吻合口狭窄	经盲襻T管窦道胆道镜扩张胆肠吻合口
2	女	39	2004年11月	术后2天发现肝总管侧壁损伤，直径2 mm	4-0线缝合	术后5年未见胆管狭窄	无
3	女	60	2009年7月	术中发现胆总管横断，胆管缺损至左、右肝管水平	左、右肝管融合，预置盲襻式胆管空肠Roux-en-Y吻合	术后6个月，胆肠吻合口狭窄	经盲襻T管窦道胆道镜扩张胆肠吻合口
4	女	60	2012年11月	术中发现胆总管前壁损伤，直径6 mm	胆总管前壁缝合，置14号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
5	男	52	2012年3月	术中发现胆总管前壁剪开，直径5 mm	胆总管前壁缝合，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
6	女	59	2014年9月	术中发现胆总管横断，胆管无缺损	胆总管端端吻合，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
7	男	70	2014年12月	术中发现胆总管横断，胆管无缺损；肝总管损伤，直径3 mm	胆总管端端吻合，缝合肝总管损伤，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
8	女	53	2017年1月	术中发现右肝管前壁损伤，直径5 mm	缝合右肝管损伤，置10号T管支撑	术后9个月造影示胆总管无狭窄，拔除T管	无
9	男	48	2017年4月	术中发现胆总管横断，胆管缺损至肝门水平	左肝管、右前肝管、右后肝管、尾叶肝管融合，行预置盲襻式胆管空肠Roux-en-Y吻合	术后23个月监测ALP、GGT轻度升高，胆红素正常，MRCP未见胆肠吻合口狭窄	无
10	男	70	2017年6月	术中发现胆总管横断，胆管无缺损	胆总管端端吻合，置12号T管	术后9个月造影示胆总管轻度狭窄，继续观察3个月，胆道镜检查未见狭窄，拔除T管	无
11	女	67	2017年9月	术中发现右肝管损伤，直径4 mm	缝合右肝管损伤，置10号T管支撑	术后6个月造影无胆管狭窄，拔除T管	无

病例	性别	年龄（岁）	手术年月	胆管损伤情况	处理	随访及并发症	并发症的处理
1	女	45	2001年9月	术中发现胆总管横断，胆管缺损至左、右肝管水平	左、右肝管融合，预置盲襻式胆管空肠Roux-en-Y吻合	术后1年，胆肠吻合口狭窄	经盲襻T管窦道胆道镜扩张胆肠吻合口
2	女	39	2004年11月	术后2天发现肝总管侧壁损伤，直径2 mm	4-0线缝合	术后5年未见胆管狭窄	无
3	女	60	2009年7月	术中发现胆总管横断，胆管缺损至左、右肝管水平	左、右肝管融合，预置盲襻式胆管空肠Roux-en-Y吻合	术后6个月，胆肠吻合口狭窄	经盲襻T管窦道胆道镜扩张胆肠吻合口
4	女	60	2012年11月	术中发现胆总管前壁损伤，直径6 mm	胆总管前壁缝合，置14号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
5	男	52	2012年3月	术中发现胆总管前壁剪开，直径5 mm	胆总管前壁缝合，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
6	女	59	2014年9月	术中发现胆总管横断，胆管无缺损	胆总管端端吻合，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
7	男	70	2014年12月	术中发现胆总管横断，胆管无缺损；肝总管损伤，直径3 mm	胆总管端端吻合，缝合肝总管损伤，置12号T管	术后9个月造影示胆总管无狭窄，拔除T管	无
8	女	53	2017年1月	术中发现右肝管前壁损伤，直径5 mm	缝合右肝管损伤，置10号T管支撑	术后9个月造影示胆总管无狭窄，拔除T管	无
9	男	48	2017年4月	术中发现胆总管横断，胆管缺损至肝门水平	左肝管、右前肝管、右后肝管、尾叶肝管融合，行预置盲襻式胆管空肠Roux-en-Y吻合	术后23个月监测ALP、GGT轻度升高，胆红素正常，MRCP未见胆肠吻合口狭窄	无
10	男	70	2017年6月	术中发现胆总管横断，胆管无缺损	胆总管端端吻合，置12号T管	术后9个月造影示胆总管轻度狭窄，继续观察3个月，胆道镜检查未见狭窄，拔除T管	无
11	女	67	2017年9月	术中发现右肝管损伤，直径4 mm	缝合右肝管损伤，置10号T管支撑	术后6个月造影无胆管狭窄，拔除T管	无

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