医源性胆管损伤14例治疗与预防

目的总结医源性胆管损伤的经验教训,探讨医源性胆管损伤的治疗与预防。方法对14例医源性胆管损伤患者的临床资料进行回顾性分析。结果 14例医源性胆管损伤均由肝外胆管手术所致,其中完全横断4例,部分撕裂5例,电钩烧伤2例,迷走胆管瘘2例,胆囊管残端瘘1例。13例患者术中发生胆管损伤,其中3例立即行胆管重建,5例立即行胆管修复,5例行单纯引流;1例术中未发现胆管损伤,损伤后3 d行胆管重建。本组死亡2例,病死率为14.3%,其余患者随访未见异常。结论胆管损伤多为医源性所致,围术期有较高的并发症发生率和病死率,严重影响患者的存活率和生活质量,目前预后不佳。

Treatment and prevention of iatrogenic bile duct injury(a report of 14 cases)

Objective To summarize the experiences and lessons from iatrogenic bile duct injury and discuss the treatment and prevention of iatrogenic bile duct injury. Methods The clinical records of 14 patients with iatrogenic bile duct injuries were studied retrospectively. Results The injuries of 14 cases were from extrahepatic bile duct operation. 4 cases were from transections, 5 cases lacerations, 2 cases were from burns, 2 cases from bile leaks and 1 cystic duct leak. In 13 patients, the injury was recognized during the operation, three of them the biliary tract was reconstructed, five of them the injury was repaired immediately and five of them were treated with simple subhepatic drainage. 1 patient with the bile duct injury was not found during the operation and the patient underwent reconstruction 3 days after the injury. 2 patients died, and other patients wen followed up. The mortality rate was 14.3%. Conclusion Bile duct injury is an iatrogenic catastrophe with significant perioperative morbidity and mortality, which had bad effect on long-term survival and quality of life. The prognosis after bile duct injury remains very poor.