术中胆道镜对诊断和处理器械所致胆管损伤的价值

目的探讨胆道手术中器械意外损伤胆管后的早期发现.方法总结1250余例术中应用胆道镜发现的14例胆管损伤,并列举转院2例术中未被发现的胆道损伤最终死亡的病例进行分析.结果14例中,胆总管下端后壁穿孔1例;右后支肝管穿透性损伤1例;胆肠吻合术时造成左肝管横断及误扎1例;取石器械穿破胆管壁至肝组织中形成假道11例,由于处理及时无并发症.结论术中应用胆道镜,有利于手术者选择正确的手术方法,遇到复杂疑难问题或有意外损伤时,能及时作出诊断,减少了术后并发症的发生,提高了胆道系统疾病的诊治水平.

The Value of Cholangioscopy on Diagnosis and Management in Biliary Duct Injury Caused by Operative Appliance

Objective To study the early discovery of unexpected biliary duct injury caused by appliance during operation.Methods Among 1 250 cases performed with cholangioscopy,14 cases of biliary duct injury were reviewed. Two cases with unrecognized biliary duct injury transmitted from other hospital during operation and died finally who were adopted as control.Results In 14 cases, one was penetration in posterior wall of lower biliary duct,one penetrated lesion of postension right branch of biliary duct,one was ligated-left biliary duct proved during the second operation in our department because of constrictive anastomotic mouth, and 11 were the formation of spurious tract between biliary duct and hepatic tissue. There were no complications due to timely management.Conclusion Cholangioscopy in operation is benefit for operator's choice of operative methods, and complex problems and unexpected, injury can be diagnosed and managed in time once they occur.