医源性胆管损伤的紧急处理

Immediate management of iatrogenic bile duct injury

目的探讨医源性胆管损伤的处理方法及注意事项。方法回顾性分析1992年10月至2005年1月西安地区会诊的13例医源性胆管损伤的术中处理方法,以及长期随访的疗效。13例中,男7例,女6例;腹腔镜胆囊切除(LC)9例,开腹胆囊切除(OC)4例。胆管横断伤5例,其中4例对端吻合术;另1例和3例胆管切除一段者,采用高位胆肠吻合术;胆管切除并左右肝管部切除5例,采用肝管Y形空肠“四针缝合法”吻合。结果随访5个月至13年,无手术死亡,无黄疸及胆道感染等并发症。结论胆管损伤一旦发生应及时处理,根据术中损伤类型,采取不同的处理方法,可获得满意的效果。

Objective To explore the management and cautions of the iatrogenic bile duct injury. Methods A retrospective study was undertaken to investigate the intraoperative procedure and the effect of long-term follow-up in 13 patients with iatrogenic bile duct injury in Xi＇an＇s hospitals from October 1992 to January. 2005. In these 13 cases.7 men and 6 women, there were 9 cases following laparoscopic cholecystectomy and 4 cases following open cholecystectomy. In the five bile duct transection,4 were underwent end-to-end anastomosis. The other one and 3 duct partial resection were performed superior position cholangiojejunostomy. The 5 patients with bile duct resection and left and right hepatic duct partial resection were treated by Roux-en-Y hepaticojejunostomy with four-needle suture. Results Following up form 5 moths to 13 years ,there were no dead cases and no complication such as jaundice and infection of biliary tract. Conclusion Once the bile duct was damaged, surgical repair should be performed immediately. The different approach should be chosen according to injury, type to obtain satisfactory effect.