医源性胆道损伤的外科治疗

目的：探讨医源性胆道损伤的原因、诊断、手术时机和手术方式的选择。方法：对28例胆道损伤进行分析总结：分别施行了胆管修补术3例、胆管端端吻合术2例和胆肠吻合术23例。结果：全组无围手术期死亡，4例术后出现胆管狭窄而再次手术，其余愈后良好。结论：尽早发现、及早正确处理对提高疗效和预防术后胆管狭窄起着决定性的作用。术中发现胆管损伤立即行端端吻合或修复加T管引流；术后数天发现或多次重建术失败，则宜行规范的胆肠Roux-en-Y吻合术。

Surgical Management of Iatrogenic Bile Duct Injuries

Objective To investigate the reason, diagnosis and treatment of iatrogenic bile duct injury.Methods Form 1980 to 1998, 28 cases of iatrogenic bile duct injuries were analyzed retrospectively. All patients were treated by operation. The operations included repair of the injured bile duct (3 cases),end-to-end bile duct anastomosis of the bile ducts (2 cases),and biliary-enterostomy (23 cases). Results There were no peri-operative deaths in the group. Four cases complicated by stricture of biliary tract afterwards received re-operation,and the other patients recovered well. Conclusions Discovery and treatment of the trauma of the bile duct as early as possible decisively affects the therapeutic results and will prevent stricture of the biliary tract after the operation.The present study suggests that to manage patient immeadiately by end-to-end anastomosis of the bile duct or repair with T tube prosthesis during the surgery is reliable. For patients the diagnosis of iatrogenic injury has been delayed or a reconstruction surgery was failed, biliary intestinal Roux-en-Y procedure is more reliable.