医源性胆道损伤的处理体会

Experience of Dealing with the Iatrogenic Wounds in Bile Duct

目的探讨医源性胆道损伤不同时机的发现、不同类型的预防及处理。方法回顾1995年1月～2009年12月收治的21例胆管损伤患者的临床资料,分析其发生的原因、部位、发现的时机及不同类型的处理方法,跟踪追访其治疗效果。结果 21例患者,治愈17例,死亡2例(全身衰竭死亡1例,并发心肌梗死死亡1例),继发性胆管狭窄2例,经再次择期行Roux-Y吻合均获治愈。随访19例,时间1～13年,随访患者均未出现胆管炎或胆瘘等症状。结论医源性胆管损伤危害是严重的,术中及时发现胆管损伤是及时处理的前提,术后诊断要及时,术式选择要合理,但避免损伤才是整个处理的关键。

Objective To research different types of iatrogenic wounds in bile duct that are discovered in different periods of time,and the prevention and dealing methods as well. Methods To look back the 21 cases with the bile duct injury that were treated in our hospital between January 1995 and December 2009 and to analyze the cause,part of the body,time of discovered,the different dealing methods,and finally the treat effects of the cases. Results Of the 21 cases,19 of them have been cured,2 of them died（one died of systemic failure and the other myocardial infarction）,and 2 suffered from ductal stricture,who were both cured finally through being treated Roux-Y tallies. None of the 19 cases that were inquired during 1～13 years suffered from symptoms like cholangietis or bile leakage. Conclusion The harm of iatrogenic wounds in bile duct is fatal. It＇s the best time to discover the disease during the operation. Also it＇s important to diagnose it in time and proper operation must be chosen. However,what matters most is to avoid the damage during the cure.