胆囊切除术致胆管损伤防治体会

The pievention and the treatment of the bile duct injuries in cholecystectomy

:目的 :探讨胆囊切除术致胆管损伤的原因、预防及治疗。方法 :回顾分析 1 4例胆囊切除术致胆管损伤的原因及治疗效果。结果 :胆囊切除术致胆管损伤有术者因素、胆道解剖异常、局部病理因素、术中出血及术中麻醉效果等。术中发现损伤及时进行吻合或修补 ,术后胆漏患者先行胆道及腹腔引流 ,3个月后再作胆道重建术 ,胆管空肠 Roux-en- Y吻合最理想。1 4例随访 1 a～ 1 6 a,效果理想。结论 :预防是关键 ,要重视胆囊切除的方法及规范手术操作 ,胆管损伤的处理应根据发现时间、部位。

Objective:To investigate and analyze the prevention and the treatment of bile duct injuries in cholecysteclomy.Method:The factors and treatment of the bile duct injuries were reviewed in 14 patients with cholecystecotomy.Result:The bile duct injuries in cholecystecotomy,related to the doctors and patient’s condition,which include the abnormal anatomy of bile duct,pathological changes around the bile duct,operative bleeding and anaesthesia,etc.The bile duct injury was recognized and repaired at the initial operation.The cases with bile lead be drainage of the bile duct and peritoneal cavity,and then secondary reconstructions of the bile duct were performed after drainage in three months Roux-en-Y choledoco-jejunostomy approach is of choice.Outcome of the 14 cases were ideal.Conclusion:The prevention is the key.The treatment principles of cholecystitis operation,the methods of removal the gallbladder and the standard operation are valuable to be paid more attention to.The treatments of biliary tract injurise should be chosen different methods according to the times of finding the injuries the positions the types,etc.