医源性肝外胆管损伤诊治探讨

目的:分析探讨医源性肝外胆管损伤的原因及处理方法.方法:对我院自1986～2003年共收治10例医源性肝外胆管损伤病人的损伤原因及处理方法进行回顾性分析.结果:胆管损伤后采取胆管对端吻合,置T型管支撑引流2例;胆总管修补,扩大原胆管破裂口,分别置T型管支撑引流各1例;拆除胆管缝线、T型管支撑引流1例;胆管-空肠Ruox-Y吻合5例.术后随访2～3年,9例效果满意,1例反复胆道感染.结论:胆囊切除术中认清肝总管、胆总管、胆囊管及其胆囊动脉的相互关系,采取顺逆结合术式,切除前遵循"辩-切-辩"三字原则是预防医源性胆管损伤的关键.损伤的类型及损伤后发现的时间决定了手术方式的选择及其治疗效果.

Analysis of diagnosis and treatment of extrahepatic bile duct injury

ObjectiveTo analyse the cause and treatment of extrahepatic bile duct injury.Methods Ten cases of extrahepatic bile duct injury collected from 1986 to 2003 were analyzed.Results Two cases treated by tip-tip anastomsis of bile duct and T-tube were placemented, one case treated through choledocho-mended , rupture of bile duct enlarged and T-tube were placemented; five cases treated though Ruox-Y anastomosis of bile duct to jejunum After operation was performed,effects of 9 cases were satisfatory during visist in 2 to 3years,only one infection of biliary tract occurred repeatedly.Conclusion To identify the relation of common hepatic duct,cystic duct and cystic artery and contra-obedient method are performed and differentiating-cutting-differentiating doctrine is the key point. Therapeutic efficacy depended on types and time of injury and manners of operation.