胆囊切除致胆管损伤原因探讨及处理

THE REASONS AND TREATMENT OF BILE DUCT INJURY IN CHOLECYSTECTOMY

目的探讨胆囊切除致胆管损伤的原因及处理措施。方法回顾性分析近7年收治27例胆囊切除致胆管损伤的临床资料。27例胆囊切除致胆管损伤病例中,实施手术34例次,其中胆肠Roux-en-Y吻合术为19例次。结果全组末次近期效果:优20例(74.1%),良6例(22.2%),死亡1例(3.7%)。随访2～7年(平均3年)20例,其中胆肠Roux-en-Y吻合术15例,优11例(73.3%),良3例(20.0%),差1例(6.7%)。结论胆囊切除术致胆管损伤,损伤的原因主要与其术式选择不当、手术时机把握不当及术者经验不足有关。胆管损伤时要取得好的疗效,关键是及时发现和正确处理。胆管空肠Roux-en-Y吻合术是大多数胆管损伤或损伤性胆管狭窄修复重建的有效术式。

Objective To investigate the reasons and treatments of the bile ducts injury in cholecystectomy. Methods Clinical data of 27 cases of the bile ducts injury caused by cholecystecto-my during 7 years were retrospectively analyzed. These 27 cases have received a total of 34 sessions procedures, choledochojejunal Roux-en-Y anastomosis in 19 sessions procedures. Results In short-term,20 cases （74. 1% ） achieved good effect, fair in 6 cases （22. 2% ） , died in 1 case（3.7% ）. In 20 cases undergoing average 3-year. following-up, Choledochojejunal Roux-en-Y anastomosis 15 cases, good 11 cases （73.3%）, fair 3 cases （20. 0% ） , bad 1 case（6.7% ）. Conclusion During cholecystectomy, the main reason of bile buct damage is belong to choose unsuitable modus operandi and improper operation opportunity and be lack of experience. The bile duct damages will be obtained good treatment result, the key is the prompt discovery and correctly treated timely. Choledochojejunal Roux-en-Y anastomosis technique is a effective method for most of the injury of bile duct and biliary strictures, cases.