医源性胆管损伤术后诊断及处理(附35例报告)

Clinical Research on Diagnosis and Treatment of Iatrogenic Bile Duct Injury:A Report of 8 Cases

目的探讨医源性胆管损伤术后诊断及处理的方法。方法回顾性总结遵义医学院附属医院肝胆外科在2003年9月至2010年12月医源性胆管损伤患者35例,其中B超检查33例,CT检查21例,MRCP 28例。处理方式:胆管结扎5例,局部修复例9例,对端吻合2例,胆管空肠Roux-en-y吻合16例,胆总管T管引流+腹腔引流3例。结果 B超检查阳性率93.94%,CT检查阳性率90.48%,MRCP阳性率78.57%。随访半年到4年,29例愈后良好(82.86%),2例愈后尚可(5.71%)3,例愈后差(8.57%),1例死亡(2.86%)。结论医源性胆管损伤检查首选B超和CT,确诊首选MRCP;其处理应遵循"个体化"原则,主流方式是胆管空肠Roux-en-y吻合术。

Objective To investigate the diagnosis and treatment methods of iatrogenic bile duct injury.Methods The diagnosis and treatment methods of 35 patients with iatrogenic bile duct injury in hepatobiliary surgery during September 2003 to April 2011 were retrospectively analyzed. Results The positive was 93.94% for B-ultrasound,90.48% for CT examination and 78.57% for MRCP. After 6-month to 4-year,follow-up,29 cases（82.86% ） were cured and 4 cases （12.43%） were failure. Conclusion B-ultrasound and CT should be first examination for iatrogenic bile duct injury and MRCP might be the first choice for the diagnosis. The treatment should follow the ＂individual＂ principle, and the mainstream approach is bile duct-jejunum Roux-en-y anastomosis.