14例医源性胆道损伤的原因及诊治体会

Cause,Diagnosis and Treatment of 14 Cases of Iatrogenic Bile Duct Injury

目的探讨医源性胆道损伤的原因并总结诊治体会。方法对1996年1月-2006年12月在宿州市第一人民医院行手术治疗的14例医源性胆道损伤病例进行回顾性分析。结果14例再手术中,12例随访1～10年均恢复良好,1例因胆囊切除术后10d胆汁性腹膜炎、感染性休克再手术后3d死于MSOF。1例肝总管端端吻合,术后仍有胆道感染症状,术后8个月再行肝总管空肠Roux-en-y吻合随访3年疗效满意。结论术中发现医源性胆道损伤应立即行胆道端端吻合或修补并置T管支撑、引流,术后发现者再手术者易出现胆道狭窄。

Objective To explore the cause, diagnosis and surgical treatment of iatrogenic bile duct injury. Methods The clinical data of 14 patients with iatrogenic bile duct injuries in our hospital from 1996 to 2006 were analyzed retrospectively. Resuits Among 14 cases, 12 cases recovered completely showed by a follow up of 1 to 10 years;1 case received re-operation because of the bilious peritonitis and infectious shock 10 days after the cholecystectomy and died of MSOF; 1 case with common hepatic duct end-to-end anastomosis received a satisfactory Roux-en-Y anastomosis between common hepatic duct and jejunum 8 months later because of postoperative infection of biliary tract. Conclusion Iatrogenic bile duct injury should be managed immediately by end-to-end anastomosis of the bile duct or repaired with T tube brace. The postoperative stenosis of biliary tract is common and more attentions should be caught.