医源性总胆管远段损伤的术中诊治与预防

Diagnosis, treatment, and prevention of iatrogenic distal common bile duct injury

目的探讨医源性总胆管远段损伤的术中诊治及预防。方法回顾性复习1990年2月至2005年2月湖南省人民医院收治的22例医源性总胆管远段损伤的病例。结果取石钳入腹膜腔（95．5％），注水试验阳性（100％）。长臂T管支撑总胆管是有效的手段。全组18例获得随访，平均20．8个月，效果满意。结论术中胆扩裸露征、注水试验是总胆管远段损伤的有效诊断手段。遵循浅、通、撑、抑四字外科原则，可获满意效果。满意的术野显露是有效的预防措施。

Objective To review the diagnosis and causes of iatrogenic injury to the distal choledochus at operation. Method The case notes of the patients with bile duct injuries that were treated in my Department from 1990.2--2005.2 were reviewed. Results To detect distal bile duct injuries, a sound in the bile duct had an accuracy rate of 95 % while injection of water into the bile duct to detect leakage had an accuracy rate of 100%. Using a long arm T tube in the common bile duct was an effec- tive method to treat the injury. In 18 patients with an average follow-up time of 20.8 months, the results were satisfactory. Conclusions Injecting water into the bile duct to diagnose distal common bile duct injury at operation was an effective way to detect distal bile duct injury. Adequate exposure of the operative field is the best method to prevent bile duct injury.