创伤性肝胆管损伤的外科处理

Surgical management of blunt intrahepatic bile duct injury

目的探讨创伤性肝胆管损伤的处理方法。方法回顾性分析近10年我院收治的220例肝创伤中12例肝胆管损伤患者的临床资料。结果除外院转入1例因来院过晚,失去手术时机衰竭死亡外,另11例均获痊愈。其中7例再手术治疗:1例持续胆漏予以近端漏口缝扎,胆总管引流;3例因反复发作化脓性胆管炎、梗阻性黄疸,行胆管空肠Roux-Y吻合术;另3例伴有肝萎缩、创伤性胆道出血分别行肝段、叶切除术。尚有4例胆漏维持通畅引流,亦获满意结果,于2周内停止胆漏。结论肝创伤合并肝胆管损伤,经初期和后期认真处理,均可获得良好预后。

Objective To explore the surgical approach of intrahepatie bile duct injury, after blunt hepatic trauma. Methods Twelve cases of intrahepatic bile duct injuries in clinical data of 220 cases of hepatic trauma in our hospital from 1997-2007 were analyzed retrospectively. Results One patient died from liver failure. Eleven patients were cured： 7 cases were cured with surgical approach： of whom, 1 case had the persistent （0.5 year） biliary fistula which was ligated and the CBD was drained with ＂T＂ tube; 3 cases had recurrent purulent cholangitis, obstructive jaundice, and were undergone hepatoeholangiojejunostomy; 3 cases with segmental hepatic atrophy and hemobilia were treated with segmental hepateetomy. 4 bile leakage patients were cured by abdominal drainage. Conclusion Surgical management of intrahepatie bile duct injury after blunt hepatic trauma can obtain satisfactory, result and good prognosis.