摘要
目的探讨胆囊切除术导致胆管损伤的原因及损伤后的处理方式。方法对21例胆囊切除术引起胆管损伤的损伤原因及处理方式的临床资料进行回顾性分析。结果损伤原因主要有:(1)胆囊急性炎症期进行手术8例,(2)经验不足5例,(3)Calot三角结构不清3例和解剖变异3例,(4)术中出血导致损伤2例。在处理方式上,本组有3例在术中发现胆管损伤后即时进行修复,12例在术后14d内修复,均取得良好的效果。另外6例在损伤后15d～95d之间进行修复,其中4例恢复良好,1例术后存在慢性胆管炎,死亡1例。绝大部分17例的病例采用胆管空肠Roux-en-Y吻合术,恢复良好15例。结论胆囊切除术导致的胆管损伤应由有经验的肝胆外科专科医生进行修复,早期修复是可行的,胆管空肠吻合术是首选的手术方式。
Objective To investigate the causes of bile duct injuries during choleeystectomy and surgical management. Methods The data of 21 cases with bile duct injuries （BDI）during cholecystectomy were analyzed retrospectively. Results The main causes of BDI were： （1）operation performed during acute eholecystitis （n=8）, （2） lack of experience （n=5）, （3）uncertain of the structure of Calot Triangle （n=3） and variable anatomical position （n=3）, and （4） intra-operation bleeding （n=2）. Operative repair was performed immediately following BDI in three cases , while the other 12 cases underwent repair in 14 clays after BDI. All these repairs succeeded. Among the six patients who underwent repair during 15 to 95 days after BDI, four patients recovered well. While another one patient had chronic eholangitis after repair, and one patient died after repair. Choledochojejunostomy was performed in 17 cases, and the success rate was 88.2% （15/17）. Conclusion Operative repair of BDI during cholecystectomy should be performed by an experienced hepatobiliary specialist. Early repair is feasible. Choledochojejunostomy is the first choice of the operative procedures.
出处
《岭南现代临床外科》
2009年第1期4-6,共3页
Lingnan Modern Clinics in Surgery
关键词
胆囊切除术
胆管损伤
修复
Cholecystectomy
Bile duct injuries
Repair
