胆囊切除术中肝外胆管损伤的类型及对策

The Type and Countermeasures of Extrahepatic Bile Duct Injuries in Cholecystectomy

目的:探讨胆囊切除术中肝外胆管损伤的类型及对策。方法:总结我院20例肝外胆管损伤类型,包括胆总管横断、肝总管横断、左右肝管汇合部损伤、右肝管损伤、副肝管损伤、胆总管灼伤,分别采用部分损伤修复、胆管端端吻合、胆管空肠Roux-Y吻合等手术,或加T管支撑引流术。结果:全部病例随访6个月至10年,3例因胆管狭窄行2次及以上手术,其余恢复良好。结论:应对术中胆管损伤的重点在于预防,强调术中及时发现损伤,依据损伤类型采用相应的处理措施。

Objective:To explore the type and countermeasures of extrahepatic bile duct injuries in cholecystectomy.Methods:20 cases of extrahepatic bile duct injury in my hospital were summarized including transection of common bile duct,hepatic duct transection,left and right hepatic duct confluence injury,right hepatic duct injury,accessory hepatic duct injury,and bile duct burns.Their part of the damage were respectively repaired: the bile duct end-to-end anastomosis,bile duct jejunum Roux-Y anastomosis and other countermeasures,or additions to the T tube drainage Support.Results:All patients were followed up for 6 months to 10 years,three cases were accepted two or more surgical treatment because of bile duct stenosis,the rest had a good recovery.Conclusion:Intraoperative bile duct injury should be focused on prevention.The timely detection of intraoperative injury should be emphasized.The appropriate measures should be used according to the injury type.