胆囊切除术中胆（肝）总管横断伤的处理（附5例报告）

目的探讨胆囊切除术中胆（肝）总管横断伤的处理对策。方法回顾性分析我院1993年1月-2008年3月3362例胆囊切除术中5例胆（肝）总管横断伤的临床特征、处理方法及效果。结果2例为肝总管横断,3例为胆总管横断伤。1例行胆肠内引流,4例行胆总管对端吻合术。术后均无胆漏并发症。1例用丝线对端吻合术后支撑管脱出,出现胆管狭窄、胆管炎2个月后改行胆肠内引流,随访15年,无腹痛、发热、黄疸发生;1例行胆肠内引流者拔除胆肠支架引流管后2个月内3次发生胆管炎,保守治疗,随访5年无腹痛、发热、黄疸发生;3例对端吻合者分别随访1、2、4年,无并发症发生。结论根据损伤胆管的类型及术者的经验,选择对端吻合或胆肠内引流处理胆（肝）总管横断伤可获得理想结果。

Treatment of Common Bile Duct or Common Hepatic Duct Transverse Injures in Cholecystectomy: Report of 5 Cases

Objective To investigate the treatment of common bile duct or common hepatic duct transverse injures （CBDTI） in cholecystectomy. Methods From January 1993 to March 2008, 3362 patients received cholecystectomy in our hospital, among them 5 developed CBDTI. We reviewed the clinic feature, management, and outcomes of these patients. Results Of the 5 patients, 2 had common hepatic duct transverse injuries and 3 showed common bile transverse injuries. One of the five received postenterobiliary drainage and the other four underwent choledoch end-to-end anastomosis. No biliary leakage was found after the operation. One patient developed biliary stenosis and cholangitis after the end-to-end anastomosis and thus received postenterobiliary drainage. This case was followed up for 15 years, during which no abdominal pain, fever or jaundice occurred. The patient who underwent postenterobiliary drainage showed symptoms of cholangitis for 3 times whithin 2 months after the treatment; therefore, conservative therapy was carried out. Afterwards, the patient was cured and showed no abdominal pain, fever or Jaundice during a 5- year follow-up. The other 3 patients who received end-to-end anastomosis were followed up for 1, 2, or 4 years, no complications were noticed during the period. Conclusions Based on personal experience and the type of injury, surgeons may chose choledoch end-to- end anastomosis or postenterobiliary drainage to treat CBDTI.