医源性胆道损伤的诊治

Diagnosis and treatment of iatrogenic biliary duct injury(a report of 20 cases)

目的 总结医源性胆道损伤的诊治经验。方法 对解放军第153中心医院22年间医源性胆道损伤的20例患者进行回顾分析。结果 经腹胆囊切除术损伤6例,腹腔镜胆囊切除术损伤10例,胆总管探查术损伤4例。损害部位:肝总管6例,胆总管1例,本组病例最终均需手术治疗,手术方式根据损伤部位、类型、损伤后发现的具体时间决定,但以规范的胆肠Roux-en-y吻合术疗效最满意。结论 术者的责任心与技术因素是引起医源性胆道损伤的重要原因。

Objective To summarizes the experience and lesson drawn from iatrogenic biliary duct injury. Methods 20 patients with iatrogenic biliary duct injuries occurred in the past 22 years were studied retrospectively. Results 6 vases were injured in cholecystectomy. 10 casesin Laparoscopic cholecystectomy gallbladder operation by peritontoscope,4 cases in exploratory choiedochostomy.The locations of injuries were 6 cases at the common hepatic duct, 9 cases at common Bile Duct, 2 cases Right hepatic duct, 1 case Left Hepatic Duct, 1 case Right substantial hepatic duct. All patients were treated ultimately by operations. The method of treatment was dallied according to the type of injury and the time after injury. The most effective operation style was the Roux-en-y cholargiojejunostomy. Conclusion The main cause of iatrogenic biliary duet injury was lock of responsibility and experence of skill of the operator during operation.