胆道探查至胆总管下端损伤的临床分析

IATROGENIC INJURY OF THE END OF COMMON BILE DUCT FROM EXPLORATION PRACTICE

目的 讨论胆道探查术中探条所至胆总管下端损伤的原因及处理。方法 对胆道探查中探条所至的 4例胆总管下端损伤 ,进行回顾性分析总结。结果 造成损伤原因主要是对胆总管下端的解剖认识不足 ,术中探查使用暴力所至。对 2例胰腺管段未穿出胰腺的损伤 ,行 T管充分引流。穿出胆管至腹膜后间隙的 1例行局部修补加 T管引流 ,另 1例因术中遗漏 ,术后死于感染中毒性休克。结论 胆总管下端损伤重在预防。损伤后以局部修补。

Objective To investigate the causes iof accidental injury at the terminations of the common bile duct during exploration of biliary tract and ways of treatment.Methods A retrospective clinical analysis was made on 4 cases suffering from iatrogenic injuries.Results Most injuries were caused by malpractice,unfamiliar with the anatomy of bile duct.In above-mentioned circumstances,T tube drainage in 2 cases with iatrogenic pancreatic traumas,plus bile duct repair in 1 case with penetrating wound to retroperitoneal space.One case died of septic shock complication because of intraoperation misdiagnosis.Conclusion We observe that the key to the treatment of iatrogenic injury of the end of common bile duct is propylaxis,immediate local repair and thorough drainage is essential to good prognosis.