Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy.
Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy.
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腹腔镜和开腹胆囊切除术中的错误陷阱和血管胆道损伤。
DOI：
10.1007/s00534-007-1267-9
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
S. Strasberg
中科院分区：
文献类型：
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作者：
S. Strasberg
许多胆道误认损伤的发生是由于错误的陷阱-方法，在大多数情况下工作，但在某些条件下容易。我们根据胆道损伤修复的丰富经验确定了四个此类陷阱。最常见的错误识别原因是“漏斗技术”错误陷阱。这个问题通常与严重的炎症有关，炎症隐藏了胆囊管并使Calot三角消失，使肝总管看起来像是胆囊壁的一部分。另一个错误陷阱-“胃底向下”胆囊切除术与损伤有关，其中损伤的血管成分甚至比胆道损伤更严重，即“血管-胆道损伤”，这些血管-胆道损伤导致肝梗死，需要肝切除，可能包括移植。与漏斗技术错误陷阱相反，胃底向下错误陷阱通常发生在中转开腹胆囊切除术后。其他两个错误陷阱是由于未能察觉存在一个异常的右肝管胆管造影和损伤的情况下，胆总管的“平行联合”胆囊管。了解这些错误陷阱及其避免方法有助于降低胆道损伤的发生率。
Many biliary misidentification injuries occur due to error traps-methods that work well in most circumstances but which are apt to under certain conditions. We have identified four such traps from an extensive experience in repair of biliary injuries. The most common cause of misidentification results from the “infundibular technique” error trap. This problem is usually associated with severe inflammation which hides the cystic duct and obliterates the triangle of Calot making the common hepatic duct appear to be part to the gallbladder wall. Another error trap — the “fundus-down” cholecystectomy has been associated with injuries in which the vascular component of the injury has been even more serious than the biliary one ie, “vasculo-biliary injuries” These vasulo-biliary injuries result in hepatic infarction requiring liver resection, possibly including transplantation. As opposed to the infundibular technique error trap the fundus down error trap usually occurs at open cholecystectomy after conversion. The two other error traps are due to failure to perceive the presence of an aberrant right hepatic duct on cholangiography and injury to the common bile duct in the case of a “parallel union” cystic duct. Knowledge of these error traps and their avoidance can help to reduce the incidence of biliary injuries.