肝外胆管外伤的损伤控制性手术治疗(附15例报道)

Damage Control Operation for Extrahepatic Bile Duct Injury(Report of 15 Cases)

目的探讨损伤控制性手术(DCO)治疗肝外胆管外伤的经验。方法回顾分析我中心2002年6月至2007年9月期间采用DCO原则治疗15例严重外伤致肝外胆管损伤患者的临床资料。结果15例肝外胆管损伤患者均按DCO原则治疗,经复苏病情稳定后再接受相应术式的再次确定性手术。本组患者无一例死亡,再次手术后发生胆瘘2例(13.3%),结肠小肠瘘1例(6.7%),切口感染、裂开2例(13.3%),急性肝功能衰竭1例(6.7%)。通过引流、对症、支持治疗后均治愈,治愈率达100%。中位随访期28个月,无一例术后出现胆管狭窄及相关并发症。结论合并肝外胆管损伤的严重外伤患者,应积极按照DCO原则,选用合适的手术方式处理,以达到提高存活率和减少并发症的目的。

Objective To explore the management strategy of damage control operation （DCO） for extrahepatic bile duct injury. Methods Clinical data of 15 cases with extrahepatic bile duct injury from June 2002 to September 2007 were selected as the object of this study. Results DCO was performed in all of 15 patients, then all cases were underwent reoperation after surgery intensive care unit resuscitation. All cases survived. Two cases （13.3%） occurred biliary fistula and 1 case （6. 7%） occurred intestinal fistula of colon after reoperation, 2 cases （13.3 % ）occurred infection and disruption of ineisional wound, and 1 ease （6.7 % ） occurred acute liver function failure. All complications were cured by drainage, symptomatic and supportive treatment. The cure rate of these 15 cases was 100%. There were no stricture of bile duet and correlative complications during 28 months of median followup. Conclusion To increase survival rate and reduce complications, severe trauma patients with extrahepatie bile duct injury should be made positively under DCO and choose eligible operations modus.