101例医源性胆道损伤的临床分析

Clinical analysis of 101 cases of iatrogenic bile duct trauma

目的探讨医源性胆道损伤的防治方法。方法对本院1990年3月至2000年3月收治的101例医源性胆道损伤资料进行回顾性分析。结果胆囊切除时胆囊三角区解剖不清是发生医源性胆道损伤的主要原因,占44.6%(45/101)。医源性胆道损伤的诊断主要依赖于临床症状体征、腹腔穿刺和影像学检查,其中 B 超诊断率可达93.9%(94/101)。按损伤部位可将其分成六型,临床上以Ⅲ型多见,占83.7%(84/101)。根据损伤类型而选择相应的外科手术方式可明显提高治愈率,本组达100%(101/101)。结论胆囊切除前遵循“辨-切-辨”三字原则是预防医源性胆道损伤的关键,而损伤类型则决定了外科手术方式的正确选择。

Objective To summarize experience in prevention and treatment of iatrogenic bile duct trauma.Methods Clinical data of 101 patients with istrogenic bile duct trauma treated in our hospital from March 1990 to March 2000 were retrospectively analyzed.Results The trauma was caused by wrong decision in identifying the anatomy of the Caloys triangle before cholecystectomy in a- bout 44.6%(45/101)of the patients.Its clinical diagnosis depended on the clinical findings,diagnos- tic abdominocentesis and imaging examination.Type B uhrasonography was the most sensitive diag- nostic means(diagnostic rate=93.9%).Six types of traumas were identified according to their loca- tions and type Ⅲ trauma was the most common one in clinical practice(84/101).Proper choice surgi- cal procedure matching the trauma type resulted in a curative rate of 100%(101/101).Conclusions The key point for prevention of istrogenic bile duct trauma lies in abiding by the sequence of“identifi- cation-excision-recognization”before cholecystectomy.The proper choice of surgical procedure is decided by the types of trauma.