医源性胆管损伤类型及处理：附64例分析

目的探讨医源性胆管损伤分类及处理方法。方法回顾性分析自1982年1月至2009年7月我科医源性胆管损伤64例临床资料。结果损伤原因：常规开腹手术（OC）45例，电视腹腔镜手术（LC）19例。损伤发现时间：术中发现30例，术后发现34例。损伤部位：胆总管上段至肝总管损伤占57．8％（37／64），胆总管下段损伤12．5％（8／64），肝管损伤29．7％（19／64）。结论肝内胆管损伤主要处理合并的肝内动脉损伤出血；胆总管下段伴胰腺损伤宜行胰头十二指肠一空肠侧侧吻合；胆总管上段一肝总管损伤方式多样；腹腔镜手术胆管损伤后无胆漏，解剖清晰可以早期修复。

Classification and treatment for iatrogenic bile duct injury: one analyse of 64 cases

Objective To investigate the classification and curative strategy for Iatrogenic bile duct injury. Methods A retrospective survey of 64 patients with iatrogenic bile duct injury from January 1982 to July 2009 was obtained to evaluate the curative effect. Results Open operation accounted for 70.3%（45/64） of iatro- genic bile duct injury, and 29.7%（19/64） occurred in laparoscopic operation. Thirty cases were found during operation, 34 cases were diagnosed after operation. 57.8%（37/64） of iatrogenic injury cases were location in upper com- mon bile duct-hepatic common duct, 12.5%（8/64 ） were in lower common bile duct, and 29.7%（19/64） of injury were in liver bile duct. Conclusions It is important to control the intrehepatic artery bleeding in iatrogenic intrahepatic bile duct injury. Iatrogenic trauma in the end part of common bile duct complicated with pancrease rupture need to be repaired with pancreaticoduodeno-jejunostomy. It need be emphasized to repair trauma according to individual featurein cases of upper common bile duct-hepatic/common duct injury. Without bile leak, bile duct injure occurred after laparoscopic operation may be safely early repaired.