胆囊切除术医源性胆管损伤的处理

Management of Iatrogenic Biliary Duct Injuries in Cholecystectomy

目的:探讨开腹胆囊切除术医源性胆道损伤的诊断、手术时机和手术方式的选择。方法:对18例胆道损伤进行分析总结:分别施行了胆管修补、T管引流术10例,保守治疗2例,Roux-en-Y胆肠吻合术6例。结果:3例术后过早拔管发生吻合口狭窄,再次手术。1例因梗阻性胆管炎并发肝功能衰竭、多器官功能衰竭死亡。1例因胆肠吻合术后并发消化道出血、肝昏迷死亡。余术后良好。结论:尽早发现及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加T管引流;术后数天发现或多次胆道修补术失败者,则宜行规范的Roux-en-Y胆肠吻合术。

Objective： To investigate the diagnosis and treatment of iatrogenic biliary duct injury （BDI） in open cholecystectomy. Methods： From 1994 to 2003, 18 cases of iatrogenic BDI were analyzed retrospectively. All the patients were treated by operation, including repair of the injured biliary ducts and T tube drainage （10 cases）,conservative therapy（2 cases）, and Roux-en-Y cholangiojejunostomy （6 cases）. Results： Anastomotic stenosis occurred in 3 cases because of early extubation, receiving reoperation. 1 case died of obstructive cholangitis complicated by liver failure and multiple organ failure.1 case died of the complication of alimentary tract hemorrhage and hepatic encephalopathy after cholangiojejunostomy. The rest recovered well. Conclusions： Discovery and treatment of the trauma of the bile duct as early as possible decisively affects the therapeutic results and will prevent stricture of the biliary tract after the operation. When biliary duct injuries are found during operation, end-to-end anastomosis plus T tube drainage should be immediately performed; if found a few days after operation or many times of failure of repair of biliary tract, Roux-en-Y cholangiojejunostomy should be performed.