医源性胆道损伤的防治

PREVENTION AND TREATMENT OF IATROGENIC BILE DUCT INJURIES

目的探讨外科手术中如何避免医源性胆道损伤。方法分析医源性胆道损伤18例的发生原因和临床资料,总结避免胆道损伤的措施。结果仔细检查胆囊床、检查有无胆汁外溢,术后观察引流管有无胆汁样液体是防止和早期诊断胆管损伤的有效措施。结论应高度重视胆囊切除手术,切除胆囊前明确分辨三管关系,以及早发现解剖变异,腹腔镜胆囊切除分离困难时及早中转开腹。如有损伤最好术中发现,及时处理,修补、吻合或胆肠吻合。

Objective To analyze how to avoid iatrogenic bile duct injuries in surgical procedures. Methods The causes and clinical data of 18 cases of iatrogenic bile duct injuries were analyzed and measures that can avoid bile duct injury were summarized. Results Based on the analytic results of all the cases, the most effective measures to avoid bile duct injury and make early diagnose were thoroughly examination of gall bladder bed and bile leakage from the pore during operation and careful observation of bile like liquid from the drainage after operation. Conclusion Surgeons should pay more attention to cholecystectomy, clearly distinguish the three tubes relationship before cholecystectomy, early detect anatomic variations, timely convert to open surgery if laparoscopic cholecystectomy is difficult to operate, timely find injures in operation and timely repair, anastomosis or biliary -enteric anastomosis.