医源性胆管损伤的原因及处理(附66例报告)

目的探讨胆管损伤和狭窄的防治方法。方法回顾性分析６６例胆囊切除（或伴）胆总管探查术发生胆管损伤及狭窄的原因和治疗。结果１３例胆管损伤在术中发现并立即修复，其中１２例手术治愈，１例术后发生胆管狭窄。５３例胆管狭窄或胆漏在术后被诊断，其中４例行胆管对端吻合（术后均复发狭窄）；４４例行胆肠Ｒｏｕｘ－ｅｎ－Ｙ吻合，３６例治愈；５例吻合口狭窄经再手术治愈。８例死亡（死于胆漏感染５例，胆汁性肝硬化３例）。结论胆管损伤若能术中发现并妥善修复常可避免发生狭窄。胆肠Ｒｏｕｘ－ｅｎ－Ｙ吻合治疗胆管狭窄可取得较好疗效。

Treatment and causes of bile duct injuries during operations on the biliary tract(a report of 66 cases)

Objective To analyze the cause and treatment of bile duct injuries during operations on the gallbladder or biliary tree.Methods The risk factors and treatment of the biliary injuries were reviewed in 66 patients with these injuries,which result from operations on the gallbladder or biliary tree.Results The bile duct injury was recognized and repaired at the initial operation in 13 patients.The repair was successful in 12 of these 13 patients.The bile duct injury was first recognized postoperatively in 53 patients,of whom 48 patients have a elective repair for biliary stricture.An end-to-end bile duct repair over a T-tube was unsuccessful in all four patients.In contrast,a biliary-enteric anastomosis with a Roux-en-Y limb of jejunum was successful in 36 of 44 patients.Conclusion Inattentive dissection of Calot's triangle and explorationof a small bile duct system may result in injury to bile duct.Immediate repair of a bile duct injury recognized at the original operation usually can avert the development of a bile duct stricture.Bile duct strictures have a good outcome with Roux-en-Y limb reconstruction.