医源性胆管损伤的原因、处理及教训

A Study on the Causes and Treatment of Iatrogenic Bile Duct Injury

目的探讨医源性胆管损伤的原因、处理方式及预防方法。方法回顾性分析我院1998年2月至2009年12月收治的医源性胆管损伤14例的临床资料。结果 14例中10例发生于胆囊切除术、1例发生于内镜下括约肌切开术(EST?、2例发生于胆总管探查、1例发生于胃大部切除术。其中高位胆管损伤5例、胆总管上段损伤6例、胆总管下段损伤2例、胆总管肝总管热源性凝固性坏死闭塞1例。治愈12例,死亡2例。结论胆囊切除术是医源性胆管损伤的首要原因,时刻警惕胆管损伤的潜在危险,术中仔细操作,是预防胆管损伤的唯一方法;胆管损伤的早期诊断及合理的胆道重建和有效的引流是挽救患者生命的关键。

Objective To investigate the causes,treatment and prevention of iatrogenic bile duct injury.Methods The clinical data of 14 patients with iatrogenic bile duct injury hospitalized between February 1998 and December 2009 were analyzed retrospectively.Results Among 14 cases,10 cases occurred during cholecystectomy,1 case occurred during EST,2 cases occurred during common bile duct exploration and 1 case occurred during subtotal gastrectomy.High biliary duct injury 5 cases,Upper choledochus injury 6 cases,lower choledochus injury 2 and Upper choledochus and common hepatic duct burn injury 1.12 cases were cured and 2 cases died.Conclusion Cholecystectomy is the leading cause of iatrogenic bile duct injury.Guarding against the potential risk of bile duct injury and performing careful operation meticulously in the intraoperative surgery is the only way to prevent the bile duct injures.Early diagnosis of bile duct injury,reasonable biliary reconstruction and effective drainage are the keys to saving lives of patients.