医源性胆总管远段损伤14例诊治分析

Diagnosis and treatment of 14 cases of iatrogenic injury in distal part of common bile duct

目的探讨医源性胆总管远段损伤的预防、早期诊断及处理。方法回顾分析14例医源性胆总管远段损伤病人的临床资料。结果14例中，术中发现12例，行胆总管穿孔修补加T管引流，术后顺利痊愈，无手术并发症发生；2例术后经T管窦道行胆道镜检查取石术，1例行ERCP／EST取石术。术后发现2例，行腹膜后脓肿引流术，1例术后4个月痊愈，1例术后3d死于感染性休克。结论医源性胆总管远段损伤重在预防，术前完善影像学检查，术中正确胆道探查，可能减少胆总管远段损伤。根据损伤情况采用相应手术方式，胆总管损伤修补加T管引流简单实用。

Objective To explore the prevention, early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 14 patients with iatrogenic injury in the distal part of common bile duct were analyzed retrospectively. Results Of 14 cases, the injury of 12 cases was found during operation,and they were treated with the perforated Common bile duct suture repair and T tube drainage,2 cases with postoperative biliary mirror stone-free,and 1 with ERCP/EST. The injury of the rest 2 cases was found after operation：one case was cured with abscess drainage after 4 months, and there was one death due to infectious shock after 3 days. Conclusion Prevention was important in iatrogenic injury in the distal part of common bile duct. The perfect preoperative imaging examination and correct bile duct exploration may reduce the occurrence rate of the injury. Different procedures should be performed according to different degrees of the injury. Perforated common bile duct suture repair and T tube drainage are simple and practical.