超声介入行损伤控制性手术在胆道损伤中的临床分析

The Application of Damage Control Operation in Ultrasound interventional treatment of Bile Duct Injury

目的分析探讨超声介入方法行损伤控制性手术(DCO)在治疗胆道损伤中的应用.方法回顾分析2003年12月至2009年12月期间超声介入方法实现DCO治疗19例胆道损伤患者的临床资料;19例胆道损伤患者均按DCO原则治疗:13例行PTCD引流胆汁,6例行腹腔穿刺引流和/或肝脓肿及胆汁瘤引流.结果19例病人中17例(89.5%)通过引流、对症、支持治疗,病情稳定接受再次确定性手术,中位随访期24个月,无术后胆管狭窄等并发症;1例病人胆汁淤积性肝硬化,等待肝移植,1例死于严重地肺部感染.结论胆道损伤严重的患者,积极按照DCO原则,选用超声介入方式恰当处理,可以达到减少并发症和提高存活率的目的.

Objective To explore the application of damage control operation（DCO）in ultrasound interventional treatment of bile duct injury.Methods Clinical data of 19 cases with severe bile duct injury from December 2003 to December 2009 were selected as the object of this study,which Ultrasound interventional method was used in the damage control operation.DCO was performed in all 19 patients.PTCD was performed in 13 patients.Abdominal paracentesis drainage and/or hepatophyma and biloma drainage was performed in 6 patients.Results Among 19 patients,17 patients underwent reoperation after patient＇s condition were ameliorated by drainage,symptomatic and supportive treatment,and no complications such as stricture of bile duct occurred during 24 months of median follow-up.Cholestasis hepatic cirrhosis was found in 1 patients who was waiting for liver transplantation.1 patient died of severe pulmonary infection.Conclusion To reduce complications and increase survival rate,severe trauma patients with bile duct injury should be made positively under DCO and choose appropriate ultrasound interventional method.