医源性胆管损伤112例的临床分析  

Clinical analysis of iatrogenic bile duct injury on 112 cases

作　　者：杨维良[1] 张东伟[1] 张新晨[1] 张浩民[2] 赵志[3] 张建国[4] 梁春林[5] 宣兆瑞 许万松[7] 孙永昌 张成[9] 范志新 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,150086 [2]齐齐哈尔医学院附属第二医院 [3]牡丹江医学院附属医院 [4]佳木斯市中心医院 [5]大庆油田总院 [6]绥化市人民医院 [7]鸡西市人民医院 [8]尚志市人民医院 [9]双城市人民医院 [10]五常市人民医院

出　　处：《中华普通外科杂志》2005年第2期76-78,共3页Chinese Journal of General Surgery

摘　　要：目的　总结医源性胆管损伤的防治经验。方法　对松花江流域10所医院1978年1月至2003年1月收治的112例医源性胆管损伤资料进行回顾性分析。结果　胆囊切除时 Calot三角区解剖不清是发生医源性胆管损伤的主要原因,占55 4%(62 112)。医源性胆管损伤的诊断主要依靠临床表现、腹腔穿刺和影像学检查,其中B超诊断率为97 5%(78 80)。按损伤部位可分为6型,临床上Ⅲ型最多见,占82 1%(92 112)。根据损伤类型选择相应术式,本组治愈率为 95 5%(107 112),其中有77 7%(87 112)采用胆管空肠Roux en Y吻合胆道重建,治愈率为94%(82 87)。结论　胆囊切除前辨清“三管”关系是预防医源性胆管损伤的关键。损伤类型决定手术方式,其中以胆管空肠 Roux en Y吻合术疗效最佳。Objective To summarize the experience in prevention and treatment of iatrogenic bile duct injury Methods Clinical data of 112 cases with iatrogenic bile duct injury in ten hospitals of Songhua river drainage area from January 1978 to January 2003 were analyzed retrospectively Results The main cause of iatrogenic bile duct injury was wrong identifying the anatomy of the Calot′s triangle before cholecystectomy accounting for 55 4% (62/112) Diagnosis depended on clinical features, celiac puncture and imaging examination Ultrasonography was among the most sensitive diagnostic means (diagnostic rate=97 5%) Six types of injury were identified according to their locations and type Ⅲ damage was most common in clinical practice (92/112) The curative rate in this group was 95 5% (107/112) Eighty seven cases (77 7%) underwent Roux en Y choledochojejunostomy, with cure rate of 94 3%(82/87) Conclusion Iatrogenic bile duct injury prevention lies in identifing the topography of extrahepatic bile ducts Roux en Y choledochojejunostomy is usually the therapy of choice

关 键 词：医源性胆管损伤 胆管空肠 胆囊切除 损伤类型 临床分析 诊断 治愈率 胆道重建 吻合 CALOT三角区 

分 类 号：R657.4[医药卫生—外科学] R656[医药卫生—临床医学]