医源性胆管损伤的处理(附156例报告)

Treatment of iatrogenic bile duct damage: report with 156 cases

目的 :探讨医源性胆管损伤后的处理方法及时机。方法 :对 2 1年中 15 6例医源性胆管损伤病例进行回顾性分析 ,以再手术率作为判断疗效标准。结果 :总的再手术率 84 .6 % (132 / 15 6 ) ,再手术与损伤原因、损伤部位、修复时机和手术操作等因素有关 (P <0 .0 5 ) ,与患者性别、年龄无显著关系 (P >0 .0 5 )。结论 :胆管损伤修复术后 ,疗效较差 ,再手术率较高。修复术力争术中、术后早期 (<4 8h内 )或 4周后处理 ,行近端胆管与空肠Roux -en -Y端侧 -侧吻合较合适 ,可减少术后胆管狭窄的发生率 。

Objective:In order to discuss on surgical treatment of iatrogenic bile duct damage.Methods:156 cases of iatrogenic bile duct damage during recent 21 years were reviewed and analyzed in this paper.Results:The total re operation rate was 84.6% (132/156),related with damage cause, damage site, the style of the first operation and operation time, but not related with sex and age( P >0.05).Conclusion:Most cases of bile duct damage needed re operation and had poor result. In this paper, we indicate that bile duct repair operation done within 48 hours or 4 weeks after damage, Roux-en-Y Cholangio-jejunostomy is the best method in dealing with damage of bile duct after 4 weeks and will reduce the rate of bile duct stenosis and improve curative effect.