医源性胆管损伤64例临床分析

Iatrogenic bile duct injuries:a clinical analysis of 64 cases

目的分析总结医源性胆管损伤诊治经验。方法回顾性分析2005年1月至2009年12月中国医科大学附属盛京医院收治的64例医源性胆管损伤病人的临床资料。结果 64例中发生于开腹胆道手术41例,腹腔镜胆囊切除术16例,其他手术7例。4例损伤较轻,术后出现胆汁瘘,行鼻胆管引流术;5例首次术中发现行损伤处T管引流术;55例行胆管空肠Roux-en-Y吻合术。1例死亡,2例吻合口狭窄再次手术,1例术后支架管脱落后吻合口狭窄再次手术,63例痊愈。结论术中发现胆管较小损伤(<3mm)慎用单纯缝合修补,应积极实施T管引流。术中发现胆管横断,术后数天发现胆管损伤或重建术失败者,胆肠Roux-en-Y吻合术为首选术式;胆肠吻合应慎用环型吻合器。

Objective To analyze and summarize the experiences of diagnosis and treatment for iatrogenie bile duct injury （IBDI）. Methods The clinical data of 64 cases of IBDI admitted between January 2005 and December 2009 in Shengjing Hospital of China Medical University were analyzed retrospectively. Results Of all 64 cases, there were 41 eases occurred in opened bile duetal surgeries; 16 cases happened in laparoscopic cholecysteetomies; 7 cases come up with other surgeries. Four cases injured with leakage of bile gently were drainage by ENBD. Five cases were found in the operation and undergone a T-tube drainage in the injured site. Other 55 cases were treated by Roux-en-Y anastomosis of bile duct and jejunum. One case died; 2 cases went through operation once again due to the stricture of the anastomotic stoma; 1 case experienced re-operation due to the defluvium of the stent tube. Sixty-three eases recovered smoothly and were followed-up over 12 months. Conclusion On condition that gentle IBDI is found in the operation, it should take simple suturing aml repairing into consideration modestly, but for a positive T-tube drainage. In case of complete truncation of the bile duct occurs in the operation, or the injury is found several days after the surgery or reconstruction surgery fails, Iloux-en-Y anastomosis of bile duct and jejunum may be the first choice, which could lead a satisfactory curative effect, while the annular anastomat should be applied cautiously.