医源性胆管损伤的手术时机与手术方式的选择

目的探讨医源性胆管损伤的原因、类型、手术时机和方式。方法回顾性总结分析2002~2007年间对26例胆管损伤的诊治过程。其中腹腔镜胆囊切除术（LC）术中损伤18例,开腹胆囊切除术（OC）8例。所有胆管损伤患者均行手术治疗,分别行胆管修补术,胆管对端吻合术,胆管空肠Roux-Y吻合术,肝门部空肠Roux-Y吻合。结果胆管修复失败的主要原因为：术式选择不当,支架放置的部位或时间不合理,延期修复的时间过长或过短。结论术中发现胆管损伤者（Ⅰ~Ⅱ型）尽可能地行胆管对端吻合术。凡是不适合于胆管对端吻合术者,首选胆管空肠Roux-Y吻合术。无胆瘘或胆汁型腹膜炎存在,术中未能及时发现者,可以行延迟性手术。吻合口〈10mm应放置支架（或支撑管,另戳孔引出体外）,拔支架时间为9~12个月。

The selection of operation opportunity and way in iatrogenic injuries of bile duct

Objective To investigate the cause、type and the opportunity of iatrogenic injuries of bile duct.Methods The clinical data of 26 patients with bile duct damage in abdominal operation from 2002 to 2007 were analyzed retrospectively.Among them,there are 18 cases in laparoscopic cholecystectomy（LC）,and 8 in open cholecystectomy（OC）.All cases with bile duct damage had undergone abdominal operation induding bile duct injury repaired、end-to-end anastomosis、Roux-en-Y hepaticoje junostomy.Results The main causes of the failure of bile duct injury repair：the unsuitable selection of operation,the support time or position unreasonable,the opportunity of postpone repair is too longer or shorter.Conclusion Bile duct in Bismuth（TypeⅠ,Ⅱ）is as far as possible end-to-end anastomosis in operation.All are not able to end-to-end anastomosis,the first choice is Roux-en-Y hepaticojejunostomy.No bile leakage or peritonitis may postpone operate.The anastomosis bore（10mm）should play the support,the time of drawing is 9～12month.