医源性胆道损伤20例分析

IATROGENIC BILE DUCT INJURY:PREVENTION AND MANAGEMENT(20 CASES REPORTS)

目的探讨医源性胆道损伤的原因、预防及处理方法。方法对2000年1月~2010年1月陕西省安康市中心医院收治的20例医源性胆道损伤的临床资料进行回顾性分析。结果开腹胆囊切除、胆总管探查及腹腔镜胆囊切除是医源性胆道损伤的主要原因,占85%。20例均行手术治疗,共行胆道重建手术23例次,其中行2次手术1例,3次手术1例。死亡2例。16例随访6个月至8年。疗效优良率达80%。结论医源性胆道损伤常见于胆囊切除术。熟悉胆道解剖及变异、严格掌握手术指征、术中肝外三管的辨认是预防医源性胆道损伤的关键。根据损伤的时间及类型采取相应的处理方法,早期发现和及时正确的处理对预后十分重要,胆管空肠Roux-en-Y吻合术是目前最常用且疗效肯定的胆道重建方法。

Objective TO investigation the causes,prevention and management of iatrogenic bile duct injury.Methods The clinical data of 20 patients with iatrogenic bile buct treated from January2000 to January 2010 were analyzed retrospectively.Results The main causes for iatrogenic bile buct injury were open cholecystectomy,common bile duct exploration and laparoscoic cholecystectomy,which account for 85%.Twenty-three bile duct reconstruction operations were performed in 20 patients.Among 20 patients,16 patients were followed up for 6 months to 8 years and the rate of satisfactory outcome was 80%.Conclusion Iatrogenic bile duct injury often occurs during cholecystectomy.Good knowledge of the anatomy and the possible variations of the bile ducts,strictly controlling of operative indications and recognition of bile cyst,common hepatic duct and common bile duct are the keys to prevent iatrogenic bile duct injury.Management accoding to the time and types of bile duct injury,early finding and timely correct management are important to the prognosis.Roux-en-Y biliary-enteric anastomosis is the commonest and the most effective meheod for the bile duct reconstructon.