医源性胆管损伤的严重后果

Severe consequence of iatrogenic bile duct injuries

目的探讨胆囊切除术中严重医源性胆管损伤的原因、处理方法、经验教训与预防对策。方法回顾性分析本院1992年10月至2005年4月共处理的202例医源性胆管损伤中9例(4．45％)致严重后果者的临床资料,以致死致残(胆道残废),处理棘手,引发医疗纠纷及耗资巨大,判定为严重后果。结果严重医源性胆管损伤中5例死亡;4例为胆道残废,赔款或继续医疗费用巨大。结论胆囊切除术或胆道探查术中注意规范性、轻柔操作、认真细致、谨慎的作风、熟悉解剖等能有效避免胆管损伤;胆管损伤后及时发现并处理效果良好;防重于治。

Objective To explore the cause, for the severe iatrogenic bile duct injuries. Methods management, experience and preventive measures A retrospective study was conducted to investigate the operative procedure and postoperative outcome of 9 patients developed death or biliary disability after severe iatrogenic bile duct injuries from October 1992 to April 2005 in our hospital. Results Of the 9 patients, 5 died and 4 had biliary disability. The 4 patients with biliary disability needed further management, resulting in increase of medical cost. Conclusions Iatrogenic bile duct injuries can be avoided in cholecystectomy or bile duct exploration by careful operation, standard procedure and well understanding of anatomic structure. Immediate repair should be performed once it occurs. Prevention of the bile duct injuries is more important than its treatment.