医源性胆道损伤治疗效果分析

目的总结医源性胆道损伤的临床治疗经验。方法回顾性分析我院外科自1989年1月至2005年1月收治的医源性胆道损伤患者38例，其中胆总管横断伤3例，行胆管端端吻合T管引流术1例，胆总管十二指肠吻合2例；肝总管横断伤6例，行胆管端端吻合T管引流术2例，胆肠Roux-en-Y吻合术4例；胆总管部损伤5例，行胆管壁缺损修补T管引流术2例，胆肠Roux-en-Y吻合术3例；肝总管部分损伤9例，行胆管壁缺损修补T管引流术3例，胆肠Roux-en-Y吻合术6例；胆总管、肝总管、左肝管缝扎各3、8、4例，均行Roux-en-Y吻合术。结果失访2例，36例获随访，时间1—14年，痊愈30例(78．9％)。胆道狭窄并结石形成3例，再次行Roux-en-Y吻合，术后反复发作胆道感染2例，死亡1例。结论医源性胆道损伤一经确诊，应有计划、有步骤地采取合理的治疗程序，术式要视损伤后时间、部位、程度及类型而定。

Therapeutic Analysis of Iatrogenic Bile Ductal Injury

Objective To summarize the experience of treating the iatrogenic bile ductal injury. Methods 38 cases of iatrogenic bile ductal injury were treated from January 1989 to January 2005, including common bile ductal transection in 3 cases treated with end to end anastomosis plus T tube drainage in 1 and choledochoduodenostomy in 2, hepatic ductal transection in 6 cases treated with end to end anastomosis plus T tube drainage in 2 and Roux-en-Y choledochojejunostomy in 4, common bile ductal partial defect in 5 cases treated with suture repair plus T tube drainage in 2 and Roux-en-Y choledochojejunostomy in 3, hepatic bile ductal partial defect in 9 cases treated with suture repair plus T tube drainage in 3 and Roux-en-Y choledochojejunostomy in 6, suture ligation of common bile duct, hepatic duct and left hepatic duct in 3,8 and 4 cases respectively which all treated with Roux-en-Y choledochojejunostomy. Result In accordance with 1 to 14 years follow-up in 36 cases, 30 cases (78.9%) cured. 3 cases experienced bile ductal stricture and lithiasis and reoperated with Roux-en-Y choledochojejunostomy, of which 1 died and 2 suffered from recurrent bile ductal infection. Conclusion A well-planed and progressive treatment should be applied once the iatrogenic bile ductal injury diagnosed, the variety of operation should depend on the lasting time, site, and severity of bile ductal injury.