胆囊切除术致胆管损伤的防治

目的　探讨胆囊切除术致胆管损伤的原因及预防、治疗。方法回顾分析１４例胆囊切除术致胆管损伤的原因及治疗效果。结果胆囊切除术致胆管损伤有术者因素、胆道解剖异常、局部病理因素、术中出血及术中麻醉效果等。术中发现损伤及时进行吻合或修补，术后胆漏患者先行胆道及腹腔引流，３个月后再作胆道重建术，胆管空肠Ｒｏｕｘ－ｅｎ－Ｙ吻合最理想。１４例随访１～１６年，效果理想。结论预防是关键，要重视胆囊切除的方法及规范手术操作，胆管损伤的处理应根据发现时间、部位、类型等选择不同方法。

The prevention and the treatment of the bile duct injuries in cholecystectomy

Objectve To investigate and analyze the causes prevention and treatment of bile duct injuries in cholecystectomy. Methods The causes and curative effect of the bile duct injuries were reviewed retrospectively in 14 patients with cholecystectomy. Results The bile duct injuries in cholecystectomy were related to the doctors and patients' condition, the abnormal anatomy of bile duct, pathological changes around the bile duct, operative bleeding and anaesthesia,etc. The bile duct injury was recognized and repaired at the initial operation. The cases with bile leakage were drained form the bile duct and peritoneal cavity,and then secondary reconstructions of the bile duct were performed after drainage in three montha. Roux-en-Y choledochojejunostomy approach was the best choice. Outcome of the 14 cases were ideal. Conclusion The prevention is the key. The methods of removal the gallbladder and the standard operation should be paid more attention to. The different methods of treatments of binary tract injuries should be chosen according to the times of finding the injuries,the positions and the types.