胆总管末端医源性损伤的诊断及处理对策

Diagnosis and treatment countermeasures of iatrogenic injury to the end of the common bile duct(IIBD)

目的探讨胆总管末端医源性损伤(IIBD)的诊断及治疗措施。方法回顾性分析24例胆总管末段医源性损伤患者的临床资料。结果术中发现15例,其中11例行胆管、十二指肠、空肠"三造瘘"+Oddis括约肌切开取石成形术,1例行Oddis括约肌切开取石术+胆肠吻合,3例行胆管长臂T管支撑引流及双套管引流,15例均治愈。术后发现9例,6例治愈,3例死于感染性休克。结论胆总管末段医源性损伤多发生于胆总管探查术中使用金属探条探查胆管下端及EST术,术中及术后早期诊断及合理的治疗方案是抢救成功的关键。

Objective To investigate the diagnosis and treatment of iatrogenic injury to the end of the common bileduct. Methods The clinical data of 24 patients were retrospectively analyzed. Results Of the 24 cases, the injures of 17 cases were found during the operation,In this 17 cases, 11 cases were treated with 3-stoma（bile duct ,pancreas .duodenum ） ＋ oddi sphincteroplasty（ OSP） , 1 case with OSP ＋ choledochojejunostomy , 5 cases with long T -tube drainage and double cannula drainge, all 17 cases were cured： The other 7 cases were found postoperation, of this 7 cases, 4 cases cured after operations, 3 cases dead from infectious shock . Conclusion The most common cause of this injury is using metal probe for exploration the end of the bile duct or EST, Early diagnosis and reasonable therapy are the key point for successful treatment.