医原性胆道损伤的诊治方法的临床探讨

Diagnosis and Surgical Management of Iatrogenic Bile Duct Injuries

【目的】探讨医原性胆道损伤的原因、诊断、手术时机和手术术式的选择。【方法】回顾性分析本院1998年1月至2005年10月治疗的各类医原性胆道损伤患者23例,其中施行胆道修补术3例,胆管端端吻合术4例,胆肠吻合术12例,胆管内置“T”型管或导尿管引流者4例。【结果】全组无围手术期死亡,所有病例随访3个月至6年余,其中3例术后出现胆管狭窄而再次手术,其余愈后良好。【结论】尽早发现、及早正确处理对提高疗效和预防术后胆管狭窄起着决定性的作用,术中发现胆管损伤立即行端端吻合或修复加T管引流;术后数天发现或多次重建术失败者,则宜行规范的胆肠Roux-en-Y吻合并“U”管引流术。

[Objective]To investigate the diagnosis and treatment of iatrogenie bile duct injury. [Methods] From 1008 to 2005, 23 eases of iatrogenic bile duet injuries were analyzed retrospectively. All patients were treated by operation. The operations included repair of the injured bile duet （ 3 eases ）, end to end anastomosis of the bile duets （ 4 eases ）, and biliary enterostomy （ 12 cases ）, drainage of T tube （ 4 eases ）. [Results] There were no peri-operative deaths in the group. Three eases complicated by stricture of biliary tract received reoperation afterwards, and the other patients recovered well. [Conclusion]Discovery and treatment of the injury of the bile duct as early as possible decisively affect the therapeutic results and will prevent stricture of the biliary tract after the operation. The present study suggests that to manage patient immeadiately by end to end anastomosis of the bile duet or repair with T tube prosthesis during the surgery is reliable. If the diagnosis of iatrogenie injury has been delayed, the reeonstruction easily fails, but biliary intestinal Roux-en-Y procedure is more reliabie.