복강경적 담낭절제술중 발생한 담관손상
Bile Duct Injury during Laparoscopic Cholecystectomy
조종현, 김재홍, 이승배, 박주섭,
소속 상세정보
조종현 ( Cho Jong-Hyun )
광주기독병원 외과
김재홍 ( Kim Jae-Hong )
광주기독병원 외과
이승배 ( Lee Seung-Bae )
광주기독병원 외과
박주섭 ( Park Joo-Seok )
광주기독병원 외과
KMID : 0371320010610040415
Abstract
Purpose : Laparoscopic cholecystectomy has replaced open surgery as the standard treatment for symptomatic cholelithiais. The combined use of ERCP and endoscopic sphincterotomy makes it possible for the diagnosis and management of common
bile
duct stones also. The authors reviewed cases for complications and clinical results in order to elucidate the efficacy of laparoscopic cholecystectomy in our hospital.
Methods : Of the 996 subjects who underwent laparoscopic cholecystectomy in our hospital between 1994 to 2000, only subjects of bile duct injury during or after the surgery were chosen for study. The clinical signs, symptoms, laboratory
data,
treatment method and complications were reviewed retrospectively.
Results : 8 patients developed bile peritonitis (0.81%), and 2 of these died of complications. Abdominal pain was noted in all patients. Intraabdominal bile collection was detected with ultrasonography (6 cases), endoscopic retrograde
cholangiopancreatography (6 cases), percutaneous transhepatic cholangiography (3 cases) and computerized tomography (1 case). Management of bile peritonitis was done with Rouxen-Y hepaticojejunostomy (3 cases), naso-biliary tube drainage (2
case),
sono-guided bile drainage (1 case) and primary closure of the common bile duct (2 case).
Conclusion : This study demonstrated that laparoscopic cholecystectomy is a relatively safe and effective approach for the management of gallstones. And though vague and non-specific, there were clinical signs and symptoms revealing bile
leakage
such as abdominal pain, tenderness, fever, jaundice and so on. Therefore, prompt and proper mana-gement for bile leakage should be accomplished to prevent lethal outcome.
키워드
복강경 담낭절제술; 담관손상; 담즙성복막염; Laparoscopic cholecystectomy; Bile duct injury; Bile peritonitis;
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