预防医源性胆管损伤243例临床分析

Experience in prevention of iatrogenic bile duct injury in 243 cases

目的:探讨医源性胆管损伤的原因及预防措施。方法:回顾我院收治的243例胆囊切除、胆总管探查手术的临床资料,对导致医源性胆管损伤的危险因素及术中实施的预防措施进行可行性分析。结果:本组病例单纯性胆囊切除术195例,胆囊切除、胆总管探查、"T"管外引流术48例,其中胆管再次手术行胆总管探查、"T"管外引流术7例。所有病例术后均痊愈出院,随访6个月～1年,无胆管损伤的发生。结论:高度的责任心、精确的手术操作是预防医源性胆管损伤的前提;熟悉胆管解剖及变异,正确把握导致胆管损伤的因素,采取有效的预防措施是预防医源性胆管损伤的关键。

Objectives：To discuss the cause and preventive measures of iatrogenic bile duct injury for preventing its occurrence. Methods：The clinical data in 243 cases of cholecystectomy,common bile duct exploration surgery treated from January 1992 to December 2008 were retrospectively analyzed on the risk factors of iatrogenic bile duct injury.The feasibility implementing intraoperative preventive measures was evaluated.Results：This group of patients contained 195 cases of simple cholecystectomy;48 cases of cholecystectomy,common bile duct exploration,and T-type tube external drainage, including 7 cases of common bile duct exploration surgery again and T-type tube external drainage.All patients were discharged from hospital after recovery and followed up for 6 months to 1 year.No case of bile duct injury occurred.Conclusion：A high degree of responsibility, gentle surgical procedure for a surgeon is a prerequisite to prevent iatrogenic bile duct injury. Being familiar with the bile duct anatomy and variations, correctly grasping the factors leading to bile duct injury,and taking effective preventive measures are keys to prevention of iatrogenic bile duct injury.