摘要
目的探讨医源性胆管损伤的临床症状分型以及相关治疗方式的选择。方法对2016年1月至2019年9月昆明医科大学第二附属医院收治的胆囊切除术后胆管损伤30例病人临床资料进行收集整理,按临床症状分组,观察术后近期和远期并发症并行疗效分析。结果①胆管狭窄组9例:早期开腹手术修复8例,其中胆肠吻合术6例,并发胆漏及狭窄各1例;超声介入治疗并发胆管炎1例。②胆漏组14例:开腹手术修复4例,并发胆漏、胸腔积液及胆管炎各1例;内镜治疗5例,复发胆漏2例;超声介入治疗5例,复发胆漏1例。③胆漏合并胆管狭窄组7例:超声介入结合开腹手术修复3例,超声介入结合内镜治疗1例,早期行胆管修补术复发狭窄1例,仅行腹腔穿刺引流术复发胆管狭窄2例。结论胆囊切除术后胆管损伤病人的治疗可以根据临床症状分型选择超声介入、内镜与开腹手术治疗。待胆管扩张后早期胆肠吻合术是胆管狭窄型肠的主要修复手段;内镜是胆漏型病人首选的微创方式;胆漏合并胆管狭窄型早期不建议开腹手术,而是有机结合三种治疗方法。
Objective To explore the classification of clinical symptoms of iatrogenic bile duct injury and the selection of relevant treatment.Methods The clinical data of 30 patients with bile duct injury after cholecystectomy in the Second Affiliated Hospital of Kunming Medical University from January 2016 to September 2019 were collected and sorted.The patients were grouped according to their clinical symptoms,and the short-term and long-term postoperative complications were observed and the curative effect was analyzed.Results In the bile duct stricture group,there were 9 cases and 8 cases were repaired by early open operation.Choledochojejunostomy was performed in 6 cases,and bile leakage and stricture complicated each 1 case.1 case was complicated with cholangitis by ultrasonic interventional therapy.In the biliary leakage group,there were 14 cases.4 cases were repaired by laparotomy,and bile leakage,pleural effusion and cholangitis were complicated each 1 case.Endoscopic treatment was performed in 5 patients and recurrent biliary leakage in 2 patients.5 cases were treated by ultrasonic interventional therapy,and 1 case had recurrent biliary leakage.In the group of biliary leakage combined with bile duct stricture,there were 7 cases.3 cases were repaired by ultrasound intervention combined with laparotomy and 1 case was treated by ultrasound intervention combined with endoscopy.There was 1 case of recurrent bile duct stricture after early bile duct repair,and 2 cases of recurrent bile duct stricture after only abdominal puncture and drainage.Conclusion Patients with bile duct injury after cholecystectomy can be treated by ultrasonic intervention,endoscopy and laparotomy according to the classification of clinical symptoms.Early choledochojejunostomy after bile duct dilatation is the main repair method for bile duct stricture type.Endoscopy is the preferred minimally invasive method for patients with biliary leakage type.In the early stage of bile leakage with bile duct stricture type,the combination of three treatments is recommended instead of open operation.
作者
翟广
钟超
李珂佳
陈晓星
郭志唐
魏东
戈佳云
Zhai Guang;Zhong Chao;Li Kejia;Chen Xiaoxing;Guo Zhitang;Wei Dong;Ge Jiayun(Department of Hepatobiliary and Pancreatic Surgery,The Second Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650032,China)
出处
《腹部外科》
2020年第6期459-462,473,共5页
Journal of Abdominal Surgery
基金
云南省科技计划项目[2017FE467(-183)]。
关键词
胆囊切除术
内镜逆行胰胆管造影术
胆肠吻合术
医源性胆管损伤
Cholecystectomy
Endoscopic retrograde cholangiopancreatography
Cholenterostomy
Iatrogenic bile duct injury
