胆囊切除术胆管损伤的诊治体会:附20例报告

EXPERIENCE OF DIAGNOSIS AND TREATMENT FOR BILIARY INJURY IN CHOLECYSTECTOMY:WITH A REPORT OF 20 CASES

目的探讨胆囊切除术有关胆道损伤的诊断、手术时机和手术方式的选择。方法回顾性分析20例胆道损伤患者的临床诊治资料,其中施行胆管修补、T管引流术9例、Roux-en-Y胆肠吻合术11例。结果术中发现胆管小裂口损伤,选择经创口整形直接放置T管支撑引流术效果良好;术中发现胆管横断伤,宜首选端对端吻合并置T管支撑引流。为防止术后胆管狭窄,放置内支撑管和良好的吻合技巧同等重要。结论掌握解剖变异、疾病病理改变,忌手术操作粗暴是防止损伤的关键。及时发现,选择适宜的修复术式,可显著降低术后胆管狭窄的发生率。

Objective To explore the diagnosis,operation time and surgical methods of the relevant bile duct injury in cholecystectomy.Methods Retrospective analysis of hospital cholecystectomy bile duct injury in the process of diagnosis and treatment of 20 typical cases.Among the above cases,9 were executed by bile duct repair and T tube drainage,and 11 were Roux-en-Y chole-enterostomy.Results Operation of small cracks found in bile duct injury choose direct placement through the wound plastic T tube drainage support good effect;surgery found in bile duct transaction injury,should the preferred end anatomists,and home support T tube drainage.In order to prevent postoperative bile duct stricture,placed inside the support tube and a good match skills were equally important.Conclusion Master anatomic variation,disease,pathological changes,gross bogey operative is to prevent the injury.Immediately found that the appropriate choice of repair type can significantly reduce the incidence of post-operative bile duct stricture.