医源性胆道损伤的原因与诊治探讨(附76例报告)

Study of causes and treatment of iatrogenic injuries of bile duct:a report of 76 cases

目的总结近20年我院收治的76例医源性胆管损伤的有关资料。方法进行回顾性分析。其中发生于胆囊切除术64例。胆总管探查术12例。15例行胆管修复或对端吻合加 T 管引流术,59例行胆管空肠 Roux—Y吻合术。结果除2例死亡,5例失访外,64例痊愈。结论作者认为术中发现胆管损伤即行对端吻合或修复加 T 管引流,术后数天发现、或多次重建术失败者.最宜行规范的胆肠 Roux—Y吻合术,疗效满意。

Seventy-six patients with iatrogenic injuries of bile duct were treated from August 1977 to August 1997 in our hospital.Among them,64 cases occurred during cholecystectomy,and 12 during ex- ploration of the common bile duct.15 cases were repaired by bile duct end-to-end anastomosis or with T tube prosthesis,and 59 cases by Roux-Y type hepatic cholangiojejunostomy.The results showed that be- sides 2 patients died and 5 patients dismissed,the rest patients recovered completely.The authors suggest that to manage patient immeadiately by end-to-end anastomosis of the bile duct or repaire with T tube pros- thesis during surgery is reliable.For patients whose treatment is delayed for several days or reconstruction surgery is failed,the Roux-Y procedure is more rialiable.