胆总管下段损伤的处理——国内文献分析

Systematic review on approaches in treating injury to the end of common bile duct

目的比较胆总管下段损伤不同处理方式之间效果的差异。方法采用“胆总管、损伤、治疗”为主题词检索维普数据库、万方数据库以及中国期刊网。纳入国内处理胆总管下段损伤的相关报道，收集其中接受不同手术方式病人的死亡率和多次手术率。结果共24篇报道151例病人纳入本研究。不同治疗方法的死亡率如下：腹腔引流术为50．0％，保守治疗为25．0％，余处理方式如损伤修补术联合管引流术、T管引流术、Oddi括约肌成形术、十二指肠旷置术、胰十二指肠切除术和胆胰分流术等治疗方法未发生死亡病例。不同术式再手术率如下：腹腔引流术为92．9％，修补术联合T管引流术为2．0％，十二指肠旷置术为100．0％，胆胰分流术为11．8％。术中明确诊断并给予处理的病人死亡率为零，术后诊断的病人死亡率为37．5％。结论处理胆总管损伤时采用损伤修补术联合T管引流术、Oddi括约肌成形术成功率较高。单纯腹腔引流术以及保守治疗效果最差。术中及时发现并处理胆总管损伤对改善病人预后至关重要。

Objective To investigate the efficacy of different approaches in treating the injury to the end of common bile duct. Methods A literature search was performed using ＂VIP database＂, ＂Wanfang database＂ and ＂CNKI＂ with the searching terms of ＂common bile duct, injury and treat- ment＂. All studies on the management of injury to the end of common bile duct were included. Studies which did not provide the detailed approach of treatment, the outcomes of patients or the injury posi- tion of common bile duet were excluded. The outcomes of patients receiving different treatment ap- proaches were collected. Results Twenty-four case serials and case reports including 151 patients were included. Twenty-four studies including 151 patients investigated the efficacy of different approa- ches in treating the injury to the end of common bile duct. The overall mortality rate was 6. 0 ~. The mortality rate of patients receiving the peritoneal cavity drainage and the conservative treatment wa~ 50. 0 ~ and 25.0 ~ respectively. The reoperation rate of peritoneal cavity drainage,T tube drainage combined with Oddi sphinctorplasty, duodenum spacious sets and bile by-pass was 92. 9 ~, 2. 0 %, 100 ~ and 11.8 ~ respectively. Twenty studies including 130 patients investigated the timing of treatment on the outcomes of the patients. The mortality rate of the patients treated during and after the operation was 0 % and 37. 5 ~ respectively. Conclusion T tube drainage combined with neoplas- ty, T tube drainage, Oddi sphincteroplasty, duodenum spacious sets and bile by-pass are accompanied with the lowest mortality rate. The peritoneal cavity drainage and the conservative treatment are corre- lated with the highest morality rate. Diagnosing and treating the injury to the end of the common bile duct during operation is crucial for the prognosis of the patients.