摘要
目的探讨医源性胆道损伤的原因及处理方法。方法对1997年3月至2010年3月收治的15例医源性胆道损伤资料进行回顾性分析。结果胆囊切除时胆囊三角区解剖不清是医源性胆道损伤的主要原因，占80．0％（12／15）。所有病例均行手术处理。术中发现10例，采用直接修补或对端吻合、T管支撑引流术7例；直接置T管引流1例；胆管与空肠Roux-en-Y吻合术2例。术后发现5例，行胆管空肠Roux-en-Y吻合术2例；行胆总管十二指肠吻合术1例，2年后因吻合口狭窄再次行胆管空肠Roux-en-Y吻合术治愈；胆总管置管引流1例；拆除胆总管前后壁之间缝线1例。全组死亡1例，生存14例全获随访，疗效优良率为80．0％。结论医源性胆道损伤常见于胆囊切除术。根据损伤的时间及类型，灵活选择适合于病人胆道损伤情况的手术方式，才能取得良好的疗效。
Objective To investigate the causes and treatment of iatrogenic bile duct injury. Methods The clinical records of 15 patients with iatrogenic bile duct injuries during March 1997 to March 2010 were studied retrospectively. Results All patients were subjected to surgical operation. In 10 cases of iatrogenic bile duct injury found intraoperationly, 7 cases received direct repair or end to end anastomosis and T tube support drainage, 1 case received direct T-tube drainage, and 2 cases received hepatic duct and jejunal Roux-en-Y anastomosis. In 5 cases found after the operation,2 cases received hepatic duct and jejunal Roux-en-Y anastomosis, 1 case received choledochoduodenostomy and the jeju- nal Roux-en-Y anastomosis was done 2 years later because of anastomotic stenosis, 1 case received common bile duct drainage, and one case was repaired by removing the sutures between the anterior and posterior wall of common bile duct. There was one death in this group, and the rest cases were followed up. The efficacy rate was 80. 0 %. Conclusion Cholecystectomy is the main cause of iatrogenic bile duct injury.
出处
《腹部外科》
2012年第1期33-34,共2页
Journal of Abdominal Surgery
关键词
胆道外科手术
手术中并发症
胆囊切除术
Biliary tract surgical procedures
Intraoperative complications
Cholecystectomy
