医源性胆管损伤的原因与处理

Causes and treatment of iatrogenic injury of biliary tract

目的:探讨医源性胆管损伤的原因和处理。方法:分析15例医源性胆管损伤病人的原因、类型、处理方法和治疗结果。结果:病人初次手术均为胆囊切除术,其中开腹胆囊14例,腹腔镜胆囊切除1例。手术中发现胆管损伤10例,其中5例于术中行对端吻合,4例行胆肠Roux-en-y吻合,1例因胆总管、肝固有动脉、门静脉横断,仅行门静脉动脉化、胆管外引流术。手术后发现5例,均接受了胆肠Roux-en-y吻合术。结论:严格遵循手术原则,大多数医源性胆管损伤是可以避免的。术中发现胆管损伤,行端端吻合为宜;术后发现宜行胆管空肠Roux-en-y吻合术,大多效果满意。

Objective：In order to discuss the causes and the treatment of iatrogenic injury of biliary tract.Methods：IS patients with iatrogenic injury of biliary tract were analyzed including the causes of injury,the methods of surgery and the results of treatment.Results：In the first operation, 15 cases were all choleccystectomy including open cholecystomy in 14 cases and laparoscopic cholecystectomy in 1 cases.Among these patients,biliary tract injury during the operation was found in 10 cases.in which 5 coses were treated with end to end anastomosis and 4 cases were treated with Roux-en-y anastomosis.Five cases of latrogentic biliary tract injury were found after operation, and reoperative patients were treated with Roux-en-y anastomosis.Conclusion：Latrogentic biliary tract injury is common compilication of cholecystectomy.Almost all operative injuries of the biliary tract are preventable if surgical principles wareperformed shrictly.The results of end to end anastomosis are satisfactory to biliary tract injuries found during operation.Choledochojejumestomy is a good surgical method for reoperative patients.