腹腔镜胆囊切除术中的血管损伤：一个经常被忽视的并发症

腹腔镜胆囊切除术是全球胃肠道手术中最常进行的手术之一。 血管损伤引起的出血并发症是发病率和死亡率的一个重要原因，尤其是在腹腔镜检查期间面临大出血时，对于没有经验的人来说，出血控制在技术上具有挑战性。 有趣的是，据报道因血管病变而中转开放手术的发生率约为 0%-1.9%，死亡率约为 0.02%。 本文的主要目的是根据现有的科学证据，对腹腔镜胆囊切除术中血管损伤的发生率和手术处理进行最新概述。

腹腔镜胆囊切除术中的胆道损伤和胆管病变的预防和处理已得到广泛研究。 然而，很少有人关注血管损伤。 血管损伤引起的出血并发症是发病率和死亡率的重要原因，也是与胆道损伤相关的胆道重建的负面结果。 应正确识别血管病变，外科医生必须根据自己的手术经验和医疗中心资源，选择最佳治疗方案，快速修复血管病变。 目前，转诊到专门的肝胆中心进行多学科治疗是强制性的。

腹腔镜胆囊切除术 (LC) 是全世界普通外科手术中最常进行的手术之一。 医源性血管和胆管损伤仍然是与医学法律影响和医疗保健成本相关的主要公共卫生问题。 腹腔镜胆囊切除术中的胆道损伤和胆管病变的预防和处理已得到广泛研究。 然而，很少有人关注血管病变。 血管损伤引起的出血并发症是发病率和死亡率的重要原因，尤其是在腹腔镜检查期间，对于没有经验的人来说，出血控制在技术上具有挑战性。 腹腔镜胆囊切除术中的血管损伤可能主要发生在套管针或气腹针插入过程中或肝囊三角解剖过程中。 有趣的是，据报道因术中血管病变而中转开放手术的发生率约为 0%-1.9%，死亡率约为 0.02%。 本文的目的是根据现有的科学证据，分析和探讨腹腔镜胆囊切除术中血管损伤的发生率、诊断和手术处理。

腹腔镜胆囊切除术中的血管损伤：一个经常被忽视的并发症

最常见的胆囊动脉变体的解剖图。胆囊动脉的常见变异。 A：胆囊动脉起源于经典位置的肝右动脉； B：胆囊管前方可见长胆囊动脉； C：胆囊动脉来自胃十二指肠动脉，经过Calot三角外； D：不是来自右肝动脉的长的单一胆囊动脉穿过肝总管前方。 RHA：肝右动脉； LHA：肝左动脉； PHA：肝固有动脉； CHA：肝总动脉； GDA：胃十二指肠动脉； G：胆囊； CHD：肝总管； CD：胆囊管； CBD：总胆管； RHD：右肝管； LHD：左肝管； AA：腹主动脉。

血管损伤是一种危及生命的并发症，在腹腔镜胆囊切除术中应与胆道损伤一起仔细评估。 必须尽早识别这些病变，外科医生必须根据可用的医疗资源为患者选择最佳治疗方案。 目前，转诊到专门的肝胆中心进行多学科治疗是强制性的。

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