医源性肝外胆道损伤26例分析

Latrogenic injury of the extrahepatic biliary tract:a report of 26 cases

目的 :为预防医源性肝外胆管损伤 ,探讨损伤的原因、预防措施和治疗方法。方法 :收集我院近 15年因肝胆胰手术、腹腔镜胆囊切除等肝外胆道损伤共 2 6例进行分析。结果 :行胆囊切除术 2 0例 ,腹腔镜胆囊切除术 6例。手术致肝总管横断2例 ,胆总管横断 7例 ,胆总管结扎 4例 ,胆总管裂伤 9例 ,右肝管裂伤 2例 ,副肝管横断 2例。结论 :胆道周围的炎症水肿、萎缩性胆囊炎、Mirizzi综合症和高位胆囊手术时易发生胆管损伤 ;门静脉高压症和术中出血 ,胆管损伤的机会增大 ;术中经验不足或过于自信亦是造成胆管损伤的重要原因。肝胆胰手术的经验积累 ,克服盲目自信 ,术中规范操作可以降低肝外胆道损伤的发生率。

Objective: To analyze the causes,prophylaxis and therapeutic methods for the iatrogenic accidental injury of biliary tract.Methods: 26 cases of the extrahepatic biliary tract injury were reviewed in our hospital during the recent 15 years for liver,biliary tract,pancreas operation,and laparoscopic (LC) cholecystectomy. Results: 26 cases of patients with biliary duct injury include 20 cases of chronic cholecystitis with stone,3 cases of acute cholecystitis,2 cases of portal hypertension with cholelithiasis,and 1 case of common bile duct cancer.20 cases were caused by cholecystettomy,and 6 cases were caused by LC cholecystectomy.These injuries included 2 cases of common hepatic duct transection,7 cases of common bile duct transection,4 cases of ligation of common bile duct,9 cases of laceration of common bile duct,2 cases of laceration of right hepatic duct and 2 cases of accessory hepatic duct transection. Conclusion: The accidental injury of biliary tract often occurred because of severe edema around biliary duct,atrophic cholecystitis,Mirizzi syndrome,and high positioned gallbladder resection.The risk of biliary tract injury is increased in the patient with portal hypertension and bleeding.Lack of operation experience can also increase the risk of injury.So the accumulation of operative experience and standardization of operative procedure is very important to prevent the iatrogenic injury of extrahepatic biliary tract.