医源性胆管损伤的解剖因素分析

Anatomic Factors Associated with Iatrogenic Biliary Injury

目的探讨容易造成医源性胆管损伤的解剖因素,以期提高手术安全性,减少胆管损伤的发生率。方法回顾性分析2000年1月至2009年8月期间昆明医学院第二附属医院收治的54例医源性胆管损伤的患者中术中记录有解剖变异因素导致胆管损伤的39例患者的临床资料。结果 39例胆管损伤按Bismuth分型分为Ⅰ型6例,Ⅱ型19例,Ⅲ型8例,Ⅳ型5例,Ⅴ型1例。解剖变异因素包括胆管变异15例,胆囊管异常10例,血管变异13例,肝门旋转1例。术中发现胆管损伤6例,术后24～72h内发现16例,术后3个月～2年出现胆管狭窄17例。39例患者中2例因肝功能衰竭或心肌梗塞死亡,4例患者失访,其余患者均经对症治疗效果良好。结论解剖因素是医源性胆管损伤的重要客观因素,重视异常的解剖可有效防止医源性胆管损伤。

Objective To investigate the anatomic factors on iatrogenic biliary injury for elevating surgical safety and decreasing incidence of iatrogenic biliary injury.Methods The clinical data of 39 patients with iatrogenic biliary injury and anatomic varied factors in operation records from January 2000 to August 2009 in The Second Affiliated Hospital of Kunming Medical College were analyzed retrospectively.Results Thirty-nine patients with iatrogenic biliary injury were divided into 5 types according to Bismuth typing,including type Ⅰ 6 cases,type Ⅱ 19 cases,type Ⅲ 8 cases,type Ⅳ 5 cases,and type Ⅴ 1 case.Anatomic varied factors included bile duct variation in 15 cases,cystic duct abnormal position in 10 cases,vascular variation in 13 cases,and porta hepatis rotation in 1 case.Biliary injuries were found during operation in 6 cases,24-72 h after operation in 16 cases,and stenosis of biliary duct was found in 17 cases 3 months to 2 years after operation.Two cases were dead because of liver function failure or myocardial infarction,withdraw was 4,the other patients were cured.Conclusion Anatomic factors are important objective elements in iatrogenic biliary injury,paying attention to abnormal anatomic factors can effectively prevent iatrogenic biliary injury.