医源性胆管损伤的预防和处理

目的：总结医源性胆管损伤的经验及教训，提出预防措施。方法：回顾性总结分析1990－2000年处理的医源性胆管损伤的情况。结果：因病理性因素手术误伤8例，因医务人员思想麻痹大意损伤4例，因先天性胆道解剖变异损伤3例。术中发现9例，及时解决；4例术后行二次手术；2例将“T”管短臂与胆总管缝扎在了一起，拔管致胆总近损伤，均经非手术（引流、止血、抗生素）治疗。15例全部治愈。结论：医源性胆管损伤的原因是多方面的，手术者责任心强，术中谨慎仔细，考虑全面，是减少医源性胆管损伤的重要环节。一旦发现胆管损伤，应及时修复，尽早处理。

PREVENTION AND TREATMENT OF IATROGENIC INJURIES OF BILIARY DUCT

Objective To explore the preventive measures by summarizing the experience in treating iatrogenic injuries of biliary duct.Methods The treatments of iatrogenic injuries of biliary duct was analyzed retrospectively.Results 8 cases of operative accidental injuries were caused by pathological factors.4 cases were caused by the operators' carelessness. 3 cases were caused by congenital anatomic variations in biliaryducts.Of them,9 cases were discovered intraoperatively,4 cases underwent a secondary operation and 2 cases of injury of common bile duct received non operative treatments such as drainage,hemostasis and antibiotic measures when the short arm of the T shaped catheter and the common bile duct were ligated together.Conclusion Iatrogenic injury of biliary duct can be caused by many factors.Operators should strengthen their responsibility to avoid its occurrence.Immediate repair and early management should be made as soon as the injury of biliary duct is discovered.