医源性胆管损伤29例回顾性分析

目的探讨医源性胆管损伤的原因、预防及处理方法。方法对2003年1月~2012年8月我院收治的29例医源性胆管损伤患者的治疗情况进行回顾性分析。结果开腹胆囊切除、胆总管探查及腹腔镜胆囊切除是医源性胆管损伤的主要原因,占69.0%（20/29）。在29例医源性胆管损伤患者中,通过姑息性引流治疗4例;再次手术25例,其中行2次手术3例,行3次胆管重建术1例,共行胆管探查及重建修复手术30次。其中19例经随访6个月~3年,疗效优良率达80%以上。结论医源性胆管损伤常见于胆囊切除术。熟悉胆管解剖及变异、严格掌握手术指征、术中肝外三管的辨认是预防医源性胆管损伤的关键。根据损伤的时间及类型采取相应的处理方法,早期发现和及时正确的处理对预后十分重要,利用胆管空肠Rouxen-Y内引流术可获得理想的治疗效果。

Retrospective analysis of 29 cases with iatrogenic bile duct injury

Objective To explore the causes,prevention and management of iatrogenic bile duct injury.Methods The clinical data of 29 patients with iatrogenic bile duct treated from January 2003 to August 2012 were analyzed retrospectively in Fuyong People＇s Hospital of Shenzhen.Results The main causes for iatrogenic bile duct injury were openly cholecystectomy,common bile duct exploration and laparoscopic cholecystectomy,which accounted for 69.0%（20/29）.Among 29 cases with iatrogenic bile duct injury,4 cases were treated by palliative drainage,and 25 cases were treated by thirty bile duct reconstruction operations,in which 3 cases had bile duct reconstruction operations twice and 1 case had bile duct reconstruction operations three times.There were 19 patients followed up of 6 months to 3 years and the satisfactory rate outcome was more than 80.0%.Conclusion The iatrogenic bile duct injury usually occurs during cholecystectomy.The keys to prevent iatrogenic bile duct injury are awareness of the anatomy and the variations of the bile duet well,control operative indications strictly and identification of common hepatic duct and common bile duct.According to the time and types of bile duct injury,early finding and timely correct management are important to the prognosis of bile duct injury.Using of Roux-en-Y biliary-enteric anastomosis can obtain ideal curative effect.