腹腔镜术中应用壶腹钟表定位法和胆囊废弃术新理念妥善处理胆囊管
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摘要
腹腔镜胆囊切除术中发生医源性胆管损伤最常见的原因就是错误地把胆总管当作胆囊管施夹离断。为了增强术者对胆囊管各种形态的辨识能力,从不同角度将胆囊管分为11类33型,应用胆囊壶腹钟表定位法和胆囊废弃术新理念为指导,把妥善处理胆囊管作为手术的首要目标和核心技术加以高度重视,从而建立了有效避免胆管损伤的手术安全策略。
Iatrogenic bile duct injury in laparoscopic cholecystectomy could happen when common bile duct was mistakenly cut off as the cystic duct. In order to enhance the ability of the surgeon to recognize various forms of the cystic duct, the cystic duct is divided into 11 categories and 33 types from different perspectives. Guided by clock positioning method for ampulla of gallbladder and the new concept of gallbladder disabled technique, the primary objective and core technique of proper management of the cystic duct are highlighted, so as to establish an effective surgical safety strategy to avoid bile duct injury.
Iatrogenic bile duct injury in laparoscopic cholecystectomy could happen when common bile duct was mistakenly cut off as the cystic duct. In order to enhance the ability of the surgeon to recognize various forms of the cystic duct, the cystic duct is divided into 11 categories and 33 types from different perspectives. Guided by clock positioning method for ampulla of gallbladder and the new concept of gallbladder disabled technique, the primary objective and core technique of proper management of the cystic duct are highlighted, so as to establish an effective surgical safety strategy to avoid bile duct injury.
引文
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[2] Barrett M,Asbun HJ,Chien HL,et al.Bile duct injury and morbidity following cholecystectomy:a need for improvement[J].Surg Endosc,2018,32(4):1683-1688.
[3] 李相成,江王杰.医源性胆管损伤分型及其意义[J].中国实用外科杂志,2018,38(9):985-988.
[4] 彭一峰,莫晔,陈国斌,等.腹腔镜胆囊动脉入路与传统入路胆囊切除术的对比分析[J/CD].中华普外科手术学杂志(电子版),2018,12(2):152-154.
[5] 刘希宁,李英俊,张瑞波,等.腹腔镜胆囊切除术中胆管损伤的处理方法探讨[J/CD].中华普通外科学文献(电子版),2018,12(6):397-399,404.
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[7] 尚培中.胆囊壶腹钟表定位法对保障腹腔镜胆囊切除安全性的指导意义[J/CD].中华普外科手术学杂志(电子版),2018,12(1):15-20.
[8] 尚培中,李晓武,苗建军,等.应用壶腹钟表定位法缩短腹腔镜胆囊切除术学习曲线[J].腹腔镜外科杂志,2018,23(7):481-485.
[9] 武凤华,尚培中,李晓武.萎缩性胆囊炎腹腔镜手术切除的安全策略[J/CD].中华普通外科学文献(电子版),2018,12 (5):297-300.
[10] 尚培中,李晓武,任爱玲.腹腔镜胆囊废弃术的选择及应用[J/CD].中华普通外科学文献(电子版),2018,12(6):376-379.
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[12] 黄志强.黄志强胆道外科[M].济南:山东科学技术出版社,1998:238-242.
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[14] 梁建伟,赫超,崔刚.先天性胆囊管并胆囊动静脉缺如1例报告[J].腹腔镜外科杂志,2017,22(10):742-742,746.
[15] 陈文山,魏天天.急性胆囊炎LC术中转开腹的危险因素及预后分析[J/CD].中华普外科手术学杂志(电子版),2018,12(4):330-332.
[16] 洪文斌,顾岩.不同手术方案在急性结石性胆囊炎患者中的应用效果对比[J/CD].中华普外科手术学杂志(电子版),2018,12(6):494-496.
[17] 尚培中,苗建军,李永庆,等.腹腔镜胆囊切除术中分类处理胆囊管结石170例[J].人民军医,2009,52(4):239-239.
[18] 尚培中.胆囊结石腹腔镜治疗今日观[J].解放军医药杂志,2015,27(11):1-5.
[19] 尚培中,苗建军,李永庆.腹腔镜胆囊切除技术个体化应用[J].人民军医,2016,59(8):852-854.
[20] 周照,朱剑飞,吴建波,等.不保留胆囊管的腹腔镜胆囊切除术[J].中国微创外科杂志,2017,17(4):337-339.
[21] 尚东,张庆凯.腹腔镜胆囊切除术胆管损伤的预防[J].中华普通外科杂志,2017,32(8):654-657.
[22] Strasberg SM,Pucci MJ,Brunt LM,et al.Subtotal cholecystectomy-“fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury:definition of the optimal procedure in difficult operative conditions[J].J Am Coll Surg,2016,222(1):89-96.
[23] Dissanaike S.A step-by-step guide to laparoscopic subtotal fenestrating cholecystectomy:a damage control approach to the difficult gallbladder[J].J Am Coll Surg,2016,223(2):e15-e18.
[24] Wakabashi G,Iwashita Y,Hibi T,et al.Tokoy Guideline 2018:surgical management of acute cholecystitis:safe steps in laparoscopic cholecystectomy for acute cholecystitis(with videos)[J].J Hepatobiliary Pancreat Sci,2018,25(1):73-86.
[25] 黄三雄,吴育连,唐成武,等.胆总管窗显露联合中路纵剖法在腹腔镜下困难胆囊三角解剖中的应用[J].中国微创外科杂志,2015,15(3):220-223,241.
[26] 刘泽良.腹腔镜胆囊切除术后胆囊管残留结石的诊治及预防体会[J].肝胆胰外科杂志,2015,27(5):406- 408.
[27] 郭鑫,张浩,李可洲.胆囊管残留综合征的临床诊治[J].腹腔镜外科杂志,2017,22(12):932-934.
[28] 滕浩鹏,曾林.腹腔镜与开腹手术在胆总管结石二次胆道手术中临床疗效对比[J/CD].中华普外科手术学杂志(电子版),2018,12(3):223-225.
[2] Barrett M,Asbun HJ,Chien HL,et al.Bile duct injury and morbidity following cholecystectomy:a need for improvement[J].Surg Endosc,2018,32(4):1683-1688.
[3] 李相成,江王杰.医源性胆管损伤分型及其意义[J].中国实用外科杂志,2018,38(9):985-988.
[4] 彭一峰,莫晔,陈国斌,等.腹腔镜胆囊动脉入路与传统入路胆囊切除术的对比分析[J/CD].中华普外科手术学杂志(电子版),2018,12(2):152-154.
[5] 刘希宁,李英俊,张瑞波,等.腹腔镜胆囊切除术中胆管损伤的处理方法探讨[J/CD].中华普通外科学文献(电子版),2018,12(6):397-399,404.
[6] 尚培中.腹腔镜胆囊切除术中胆囊壶腹钟表定位法的研究及应用分析[J].人民军医,2017,60(11):1088- 1091.
[7] 尚培中.胆囊壶腹钟表定位法对保障腹腔镜胆囊切除安全性的指导意义[J/CD].中华普外科手术学杂志(电子版),2018,12(1):15-20.
[8] 尚培中,李晓武,苗建军,等.应用壶腹钟表定位法缩短腹腔镜胆囊切除术学习曲线[J].腹腔镜外科杂志,2018,23(7):481-485.
[9] 武凤华,尚培中,李晓武.萎缩性胆囊炎腹腔镜手术切除的安全策略[J/CD].中华普通外科学文献(电子版),2018,12 (5):297-300.
[10] 尚培中,李晓武,任爱玲.腹腔镜胆囊废弃术的选择及应用[J/CD].中华普通外科学文献(电子版),2018,12(6):376-379.
[11] Strasberg SM,Eagon CJ,Drebin JA.The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy-the danger of the false infundibulum[J].J Am Coll Surg,2000,191(6):661-667.
[12] 黄志强.黄志强胆道外科[M].济南:山东科学技术出版社,1998:238-242.
[13] 戴海粟,陈志宇.肝门部解剖变异与腹腔镜胆囊切除术中胆管损伤[J].中华普通外科杂志,2017,32(8):661- 664.
[14] 梁建伟,赫超,崔刚.先天性胆囊管并胆囊动静脉缺如1例报告[J].腹腔镜外科杂志,2017,22(10):742-742,746.
[15] 陈文山,魏天天.急性胆囊炎LC术中转开腹的危险因素及预后分析[J/CD].中华普外科手术学杂志(电子版),2018,12(4):330-332.
[16] 洪文斌,顾岩.不同手术方案在急性结石性胆囊炎患者中的应用效果对比[J/CD].中华普外科手术学杂志(电子版),2018,12(6):494-496.
[17] 尚培中,苗建军,李永庆,等.腹腔镜胆囊切除术中分类处理胆囊管结石170例[J].人民军医,2009,52(4):239-239.
[18] 尚培中.胆囊结石腹腔镜治疗今日观[J].解放军医药杂志,2015,27(11):1-5.
[19] 尚培中,苗建军,李永庆.腹腔镜胆囊切除技术个体化应用[J].人民军医,2016,59(8):852-854.
[20] 周照,朱剑飞,吴建波,等.不保留胆囊管的腹腔镜胆囊切除术[J].中国微创外科杂志,2017,17(4):337-339.
[21] 尚东,张庆凯.腹腔镜胆囊切除术胆管损伤的预防[J].中华普通外科杂志,2017,32(8):654-657.
[22] Strasberg SM,Pucci MJ,Brunt LM,et al.Subtotal cholecystectomy-“fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury:definition of the optimal procedure in difficult operative conditions[J].J Am Coll Surg,2016,222(1):89-96.
[23] Dissanaike S.A step-by-step guide to laparoscopic subtotal fenestrating cholecystectomy:a damage control approach to the difficult gallbladder[J].J Am Coll Surg,2016,223(2):e15-e18.
[24] Wakabashi G,Iwashita Y,Hibi T,et al.Tokoy Guideline 2018:surgical management of acute cholecystitis:safe steps in laparoscopic cholecystectomy for acute cholecystitis(with videos)[J].J Hepatobiliary Pancreat Sci,2018,25(1):73-86.
[25] 黄三雄,吴育连,唐成武,等.胆总管窗显露联合中路纵剖法在腹腔镜下困难胆囊三角解剖中的应用[J].中国微创外科杂志,2015,15(3):220-223,241.
[26] 刘泽良.腹腔镜胆囊切除术后胆囊管残留结石的诊治及预防体会[J].肝胆胰外科杂志,2015,27(5):406- 408.
[27] 郭鑫,张浩,李可洲.胆囊管残留综合征的临床诊治[J].腹腔镜外科杂志,2017,22(12):932-934.
[28] 滕浩鹏,曾林.腹腔镜与开腹手术在胆总管结石二次胆道手术中临床疗效对比[J/CD].中华普外科手术学杂志(电子版),2018,12(3):223-225.