医源性胆管损伤分型及优化处理规范探讨

目的 研讨一种科学的胆管损伤分型标准,用以规范胆管损伤的诊断并指导临床治疗.方法 回顾分析52例胆管损伤的临床资料,研究其损伤特点、处理方式及治疗效果,并总结复习相关文献.结果 本组病例根据不同的胆管损伤类型,指导治疗方案,对术中及术后不同时期发现的胆管损伤,分别行一期胆道修复、外引流或胆肠吻合等不同方法合理处理,术后随访,发生胆道狭窄8例,11例常伴有右上腹不适,33例随访期恢复良好.结论 胆管损伤的疗效受损伤类型和恰当的处理方案等因素的影响.科学合理的胆管损伤分型和基于该分型而采取的处置原则,能减少并发症及提高治疗效果,可以作为胆管损伤后规范治疗的参考.

A dissiction on iatrogenic biliary damage classification and optimization disposal standard

Objective To study and discuss a science of biliary damage classification so as to regulate biliary damage diagnosis and guide clinical treatment.Methods Fifty-two clinical cases with biliary damage were retrospectivly analyzed and the biliary damage characteristics,therapy and treatment effect were studied.At the same time the related papers were reviewed.Results According to biliary damage types,therapeutic schedule were directed in those cases.When bile duct damage were in different period of intraoperative and postoperative,the different methods were reasonably utilized(respectively the one-stage operation to repair bile duct damage,external drainage or choledochojejunostomy,and so on).Biliary narrow occurred in 8 cases,11 cases was often accompanied with right epigastric discomfort,33 cases good recovery in follow-up.Conclusion The types of injury and proper therapy can affect biliary damage curative effect.Scientific and reasonable classification in biliary damage and principles of surgical treatment based on the classification can reduce the complications and improve the treatment effect,and serve as the reference of standardized treatment after biliary damage.