胆囊切除术中的医源性胆道损伤

Iatragenic injuries of bile duct during cholecystectomy

本文报道１９８５年１月至１９９６年发生的８例医源性胆道损伤的有关资料，着重对经腹胆囊切除术造成的肝外胆道损伤的发生原因进行分析：①术者对胆囊切术的潜在危险性认识不足；②术中操作不细致；③术者对异常胆道缺乏认识，判断失误。并对预防术中医源性胆道损伤提出几点建议，同时对医源性胆道损伤的处理予以讨论，认为术中发现胆道损伤应当立即修复（首选对端吻合），如出现胆漏者宜先作腹腔引流，胆道引流，二期再作胆管－空肠Ｒｏｕｘ－ｙ吻合术。

8 patients with iatragenic injuries of bile duct during cholecystectomy were treated from January 1985 to July 1986 in our hospital. Iatragenic extrahepatic bile duct injuries may be caused by some errors during cholecystectomy. The operator did not realize that cholecystectomy itself is a procedure with potential risks. The operator was careless and did not anatomize 'Three Duct' carefully(common bile duct, common hepatic duct and cystic duct). The operator failed to recognize abnormal bile duct. We made several suggestions to prevent the injures during cholecystectomy. In addition, we discussed the management of bile duct in j uries and came to the conclusion that intraoperative injuries of extrahepatic bile duct should be reconstructed immediately including end to end anastomoses of the injuries of bile duct. While a postoperative bile leakage, a second - stage reconstruction of the bile duct following drainage of peritoneal cavity and/or T tube of bile duct drainage is cholecystojuj unostomy(roux - en - y).