胆管缺损的处理(附22例报告)

目的 提高病理性和医源性胆管缺损(损伤)的诊断与手术修复水平。方法 总结1992年2月～2001年2月手术治疗22例胆管缺损的经验。结果 胆管缺损22例(病理性16例、医源性6例),20例在首次手术中得以及时发现并处理、有2例LC胆管损伤在术后35、45小时二次手术,其中1例因胆管狭窄,半年后第三次行胆肠Roux-en-y。17例经过1～8年随访,无胆管狭窄发生。结论 术中及时发现胆管损伤,力争首次修复成功是治疗的关键。术后发现或是首次处理不当并发生胆管狭窄者,应严格把握修复术式的适应证,以免出现更严重的后果。

Surgical treatment of defective bile duct

Objective To sum up the experiences of the diagnosis and restorative operation for pathological and iatrogenic bile duct injuries. Methods A retrospective analysis was made for the therapeutic experiences of 22 cases with bile duct injury from Feb. 1992. to Feb. 2000. Results 20 cases with bile duct injury (pathological 16 cases and iatrogenic 6 cases) happening during the operation were properly treated. 2 cases with bile duct injury diagnosed in 35 and 45 hours after operation respectively had second operation for repair. Six months after repair surgery 1 case had Roux-en-y choledocho-jejunostomy for bile duct stricture caused by LC. During the follow-up survey for 1-8 years 17 cases were living in good condition without bile duct stricture. Conclusions Bile duct injury shouled be prevented and treated while it happening during the operation. The primary repair is most important for achieving successful result. Otherwise, the bile duct stricture is the complicated problem to be treated.