医源性胆管损伤的体会(附23例报告)

Comprehension of iatrogenic bile duct injury (a report of 23 cases)

目的探讨医源性胆管损伤的原因与防治。方法主要诊断方法为B超、瘘管造影、MRCP和ERCP检查。术中确诊后行胆管对端吻合或胆管空肠Roux-Y型吻合术。结果本组6例行胆管对端吻合,效果最好;17例行胆肠吻合,其中7例效果较好,5例偶有腹痛,2例反复发生胆管炎,1例死亡。结论应重视医源性胆管损伤,合适处理是避免并发症及后遗症的关键。

Objective To explore the cause of iatrogenic bile duct injury, its prevention and treatment. Methods The main diagnostic method were B-type ultrasound, fistulography, MRCP and ERCP examinations. When the bile duct injury diagnosed, end-to-end anastomosis of the injured duct or jejuno-biliary ducts anastomosis were performed immediately. Results In this group, 6cases end-to-end anastomosis of the injured duct recovered soon and had better effect; 17 cases jejuno-biliary ducts anastomosis were as follows： 7cases had good results, 5cases were with seldom abdominal pain, and 2patients had repeat cholangitis, 1 case died. Conclusion It is important to pay attention to iatrogenic bile duct injury, to treat it properly can avoid complications and sequelae.