胆囊切除致胆道损伤的处理经验

Experience in dealing with iatrogenic bile duct injury due to laparoscocpic cholecystecomy

目的探讨胆道损伤后的特点及处理。方法对2005--2009年收治的24例胆道损伤资料进行分析。结果胆道损伤早期手术8例，胆道损伤后期择期手术14例，黄疸自行消退未行手术2例。22例手术患者术后均安放支撑管8—14个月，中位时间8个月，随访1年6个月至5年，患者未出现再次胆道梗阻症状。结论4d以内的早期胆道损伤处理较易，晚期胆道损伤应择期手术。黄疸患者需行PTCD造影和ERCP观察胆道损伤情况。手术要力争做到胆管断端分离适当，吻合口直径要尽可能大，尽量用可吸收无创单股缝线做缝合，务必将胆管黏膜及肠管黏膜平行吻合，以减少胆肠吻合口瘢痕收缩。吻合口安置引流管作支撑，支撑管需放置8个月以上。

Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months imoroves success rate in the process of iniuried bile duct repair.