手术治疗医源性胆管损伤的临床体会

Clinical experience of reoperation in treating of iatrogenic bile duct injury

目的总结医源性胆管损伤的诊治方法及再手术要点。方法回顾性分析2008年1月至2013年12月收治的医源性胆管损伤病人的临床资料。结果总计32例医源性胆管损伤:发生于胆囊切除手术19例,胆管探查手术8例,肝切除手术5例。治疗方法:4例病人行非手术治疗,28例病人行手术治疗。手术方式:胆管修补术7例,胆管端端吻合术1例,胆管结扎线松解1例,胆管空肠Roux-en-Y吻合术13例,肝叶切除+胆管空肠Roux-en-Y吻合术4例,肝叶切除术2例。32例病人中:术后1例反复发作胆管炎,1例胆肠吻合口狭窄再次手术,2例死亡,其余28例随访期内恢复良好。结论医源性胆管损伤再手术的成功,有赖于丰富的胆道外科经验和精准的胆道外科技术,对于吻合口狭窄或重建手术失败者,胆管空肠Roux-en-Y吻合术为推荐术式。

Objective To analyze and summarize the treatments for iatrogenic bile duct injury and the essentials of reoperation. Methods The clinical data of 32 patients with iatrogenic bile duct in- jury who were admitted from Jan. 2008 to Dec. 2013 were retrospectively analyzed. Results Of all the patients, there were 19 cases in cholecystectomy, 8 cases in exploration of common bile duct, and 5 cases in hepatectomy. Four patients underwent non-operative treatment and 28 patients underwent re- operation. And 7 cases received biliary repair, 1 case received end to end bile duct anastomosis, 1 case received ligature lysis, 13 cases received Roux-en-Y anastomosis of bile duct and jejunum, 4 cases were treated by hepatectomy ＋ Roux-en-Y anastomosis of bile duct and jejunum, and 2 cases were treated by hepatectomy. Among them, there was 1 case who had repeated attack of cholangitis, 1 case went through operation once again due to the stricture of the anastomotic stoma, and 2 cases died. Twenty-eight cases recovered well during the followed-up period. Conclusions The successful reopera- tion of iatrogenic bile duct injury relies on great specialized surgical experience and precise surgical skills. In case of anastomotic stricture or the reconstruction surgery fails, Roux-en-Y anastomosis of bile duct and jejunum is the recommended operative method.