医源性肝外胆管离断伤一期胆管对端吻合修复的临床体会

Experience in the repair of one stage biliary duct end to end anastomosis for iatrogenic extrahepatic duct transection

目的探讨医源性肝外胆管横断伤的一期胆管对端吻合修复的手术适应症、手术技巧及相关并发症。方法对我院于2007年至2011年间诊治的13例医源性肝外胆管横断伤病人的临床资料进行回顾分析。所有胆管损伤患者均行开腹手术治疗,对其中的9例患者行一期胆管对端吻合修复术。结果 9例行一期胆管对端吻合修复的患者有3例术后出现胆漏,通畅引流及积极保守治疗后治愈,痊愈出院。短期随诊,未有发生胆道狭窄及胆道梗阻现象。结论选择合适的医源性肝外胆管横断伤的病例行一期胆管对端吻合修复是安全有效的。精确的胆道吻合技法是保证一期胆管对端吻合修复手术成功的关键。

Objective To investigate the operation indication, surgical skills and related complications in the repair of one stage biliary duct end to end anastomosis for iatrogenic extrahepatic duct transection. Methods From January 2007 to December 2011, the clinical data of 13 cases with iatrogenic extrahepatie duct transection were analyzed retrospectively. All cases underwent open abdominal surgery. Among them, 9 cases underwent the repair of one stage biliary duct end to end anastomosis. Results In the 9 cases underwent one-stage biliary duct end to end anastomosis, 3 cases occured biliary leakage after operation and these cases were cured by catheterized drainage and aggresive conservative treatment. No biliary duct stricture and obstruction were found during short-term follow-up peroid. Conclusion One stage biliary duct end to end anastomosis is safe and effective method for selecting suitable case of iatrogenic biliary duct transection. Precise biliary duct anastomotie techniaue is successful key in the one stage biliarv duct end to end anastomosis.