医源性胆管损伤一期修复31例体会

Primary repairing for iatrogenic injury of bile duct:a study of 31 cases

目的探讨医源性胆管损伤后首次修复的体会。方法回顾性分析和总结2004年1月至2010年6月安徽省立医院普通外科出现和收治的31例医源性胆管损伤一期修复的病例资料。结果术中发现即时修复4例,修复方式为胆管修补+胆管引流术。合并胆汁性腹膜炎6例,均先行腹腔+胆管引流术,2个月后再行胆管-空肠Roux-en-Y吻合术。合并黄疸21例,均行胆管-空肠Roux-en-Y吻合,其中损伤后10d内修复5例,10d后修复16例,10d内进行修复者所需手术时间较10d后修复者长(P<0.05)。术后均无胆漏出现,获得随访28例,随访4～60个月,2例术后1年出现吻合口狭窄,一期修复成功率为92.9%(26/28)。结论胆管损伤的处理应由有经验的胆道专科医师进行,单纯梗阻型胆管损伤10d后进行操作较容易,以胆管-空肠Roux-en-Y吻合为最佳术式。

Objective To explore the experience of primary repairing for iatrogenic injury of bile duct. Methods The clinical data of 31 cases of primary repairing for iatrogenie injury of bile duct admitted from January 2004 to June 2010 in the Department of General Surgery of Anhui Province Hospital were analyzed and summarized retrospectively. Results Four eases were found and repaired by biliary tract repairing and drainage during the first operation. Six cases of iatrogenie injury of bile duct combined with bile peritonitis were performed abdominal and biliary drainage firstly and then performed Roux-en-Y bile duct-jejunostomy after 2 months. Twenty-one cases combined with jaundice were performed Roux-en-Y bile duct-jejunostomy. Among them, injury repairs in 5 cases were performed within 10 days. Sixteen cases were performed in 10 days after the repairing. The former operation took more time than the latter （P〈0.05）. No postoperative bile leakage occurred. Twenty-eight cases were followed up for 4-60 months. Two cases occurred anastomotic stenosis after one year. The restoration success rate was 92.9% （26/28）. Conclusion Repairing bile duct injuries need to be performed by biliary surgical specialists. The obstruction of bile duct injury should be performed operation after 10 days easier than within 10 days. Roux-en-Y bile duct-jejunostomy is the best surgical procedure for iatrogenic injury of bile duct