Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

带血管蒂组织瓣在医源性胆道损伤中的应用

目的探讨带血管蒂组织瓣在医源性胆道损伤中的手术方式及效果。方法对于11例腹腔镜胆囊切除术后胆道损伤的患者,分别使用脐静脉瓣、胃瓣、胆囊瓣、空肠瓣以及圆韧带瓣进行修复。结果胆道修复术采用脐静脉瓣1例、胃瓣1例、胆囊瓣1例、空肠瓣4例以及圆韧带瓣4例。有1例患者术后出现胆瘘。所有患者于出院后肝功能指标及胆道影像学表现均基本正常。结论医源性胆道损伤修复手术为围肝门操作的精细手术。带血管蒂组织瓣修复重建术在恢复胆道连续性以及降低术后并发症方面具有很好的效果。

医源性胆道损伤(附31例分析)

报告医源性胆道损伤31例，其中院内5例，占同期胆囊切除术的0．13％；院外转来14例；院外会诊12例。胆管横断8例，右副肝管横断2例，胆管结扎8例，胆管狭窄13例中9例原系胆管横断，在当地行胆管对瑞吻合后发生狭窄。全组除1例行胆管对端吻合外，均行胆管空肠Roux－en－y吻合术。住院死亡3例，均系胆管狭窄合并胆汁性肝硬化患者。

医源性胆管损伤早期处理失败的原因分析

目的 分析医源性胆管损伤早期处理失败的原因 ,以提高治疗水平。方法 自 1989年 1月至 2 0 0 2年 10月 ,共收治医源性胆管损伤 16 0例 ,其中 82例胆管损伤后进行了早期手术处理。男 35例 ,女 4 7例。年龄2 6～ 75岁 ,平均 4 5 7岁。结果 75例效果较差 ,需再次手术。结论 胆瘘。

损伤性胆管狭窄的外科治疗

目的评价损伤性胆管狭窄的外科治疗效果。方法总结了近8年来收治的56例医源性胆管狭窄病例。其中男性26例,女性30例。行开腹胆囊切除术致伤者36例,占64.29%.腹腔镜胆囊切除术损伤4例,胆总管探查术损伤14例。损伤后距来我院的时间以半年至2年为最多,治疗多已属后期,且胆管狭窄部位高。56例病人在我院进行了胆肠通路的重建手术或胆管狭窄的修复手术。结果随访率(51/56)为91.07%,50例随访时间超过2年,3例因狭窄复发再次手术。疗效,优良率为90%。本组无手术死亡。结论研究表明 Roux-en-Y 胆肠吻合术是治疗胆管狭窄尤其部位较高。狭窄段较长的胆管狭窄的有效方法。利用带蒂胆囊瓣。空肠瓣和胃壁瓣修复胆管也取得了良好疗效。同时进行胆管内支撑有助于提高疗效,防止胆管再狭窄。

医源性胆管损伤胆管空肠吻合有关的手术技巧

胆囊切除术是胆囊良性疾患的经典术式，也是普通外科最常做的手术。胆囊切除最严重的手术并发症之一是胆管损伤。既往，医源性胆管损伤少见，随着胆囊切除数量的急剧增加，医源性胆管损伤的报道屡见不鲜。黄晓强等收集1995年1月至2001年1月6年间，全国各级期刊165个医疗单位报道的医源性胆管损伤2742例，其中94％与胆囊切除手术有关。