医源性胆管损伤与胆管狭窄治疗体会

Treatment of iatrogenic bile duct injury and bile duct stricture

目的分析与研究医源性胆管损伤与胆管狭窄的原因以及治疗方法。方法本研究选择80例医源性胆管损伤与胆管狭窄的患者进行研究,利用经内腔镜逆行性胰胆管造影技术在患者体内置放支架,对医源性胆管损伤与胆管狭窄情况进行治疗,手术之后的第1、4、7及11d对患者的肝功能变化情况进行检测,对患者血白细胞水平的计算采用流式细胞术,对患者住院的时间、临床上的治愈率以及手术之后第1、3、5年的复发率进行观察。另外,还要对比分析这些患者医源性胆管损伤与胆管狭窄情况的致伤原因以及治疗结果。结果术后治愈73例患者,治愈率为91.2%,术后的第1、4、7及11d,患者总胆红素、血白细胞水平、丙氨酸转氨酶等均有显著的下降趋势。比较手术后第1d和第7d患者各项指标的数值,存在的差异具有统计学意义(P<0.05);对比第7d和第11d,各项指标之间的差异不具有统计学意义(P>0.05)。结论作为胆囊切除手术当中一种常见的并发症,医源性胆管损伤与胆管狭窄在注意遵循及掌握手术原则的前提下,大多数是可以避免的。在提高其远期疗效方面利用经内腔镜逆行性胰胆管造影技术在患者体内置放支架这种治疗方法效果显著,特别是对于胆道狭窄的直径>3mm的。

Objective To analyze and study the causes and treatment methods of iatrogenic bile duct injury and bile duct stenosis. Methods Totally 80 cases of patients with iatrogenie bile duct injury and bile duct stricture study by endoscopic retrograde cholangiopancreatography technology placed in vivo in patients with stents, treatment of iatrogenic bile duct injury and bile duct stricture ,after surgery,4,7 and 11 days in patients with liver function changes were detected by flow eytometry, the calculation of the level of white blood cells in patients with the time of hospitalization, the clinical cure rate after surgery 1,3,5 -year relapse rate were observed. Also, comparative analysis of the causes of injury and treatment outcomes of these patients with iatrogenic bile duct injury and bile duct stenosis. Results Totally 73 patients with postoperative cure,the cure rate was 91.2%, 4,7 and 11 days of the postoperative patients with total bilirubin, white blood cell levels, and alanine aminotransferase showed a significant downward trend. 1 day and 7 days after surgery in patients with the index values, the difference was statistically significant （ P 〈 0. 05 ） ; Contrast to the first 7 days and 11 days, the differences between the various indicators was no statistically significance （P 〉 0. 05 ）. Conclusions As a common complication among cholecystectomy iatrogenic bile duct injury and bile duct stenosis in attention to follow and grasp of surgical principles, under the premise that most can be avoided. By endoscopic retrograde cholangiopancreatograplay technology to improve its long - term efficacy in vivo in patients with placement of the stent of this treatment effect was significant,especially for biliary stricture diameter 〉 3mm.