胆道损伤的处理

目的 探讨胆道损伤的分类和临床特点。方法 回顾性分析临床资料，72例胆道损伤中，医源性49例，外伤性23例(胆总管下段损伤5例，胆总管上段／肝总管损伤50例，肝内胆管损伤17例)，经局部缝合、组织修补、胆肠吻合等方式治疗。结果 全组发生胆漏2例，死于胆道感染、出血2例；随访66例，发现胆道狭窄4例，结石复发3例。结论 应努力避免和及时发现胆道损伤，根据损伤部位、类型、程度、特点分类，采取不同方式修复胆道损伤，并保证修复后胆道血供良好。

Management of bile duct injuries

Objective To classify the bile duct injuries and investigate their clinical features. Methods The clinical data of 72 cases of bile duct injuries were retrospectively analyzed. Of the 72 cases, 49 were iatrogenic injuries and 23 traumatic injuries. As for position of the injuries, it was the inferior section of common bile duct in 5, superior section of the common bile duct/main hepatic duct in 50 and intrahepatic bile duct in 17. The patients were treated by cleft suture, repairing with tissue patch or biliary-enteral anastomosis. Results Bile leak occurred in 2 cases and 2 patients died of biliary infection and bleeding after operation of repairing. The follow-up study in 66 cases showed that bile duct stricture occurred in 4 and hepatobiliary lithiasis in 3. Conclusions Great efforts should be made to avoid bile duct injuries. The injuries should be promptly found if there are any in clinical practice. The injuries should be repaired by different means according to their position, type, degree and feature. Meanwhile, the blood supply of the bile duct should be ensured after the repairing.