医源性胆管损伤诊治的临床研究  

Clinical research of diagnosis and treatment in iatrogenic bile duct injury

作　　者：雷鹏 赵国忠[2] 

机构地区：[1]宁夏煤炭总医院,宁夏大武口753000 [2]宁夏医学院附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2007年第3期223-225,共3页Ningxia Medical Journal

摘　　要：目的分析医源性胆管损伤发生的原因、临床特点和诊断方法。方法对41例医源性胆管损伤病例进行回顾性分析。结果41例中除1例术中死亡外,其余40例均采用不同手术方法进行胆道重建,其中术中发现处理的16例,再手术者3例,再手术率为18.8%;术后发现的24例,再手术者12例,再手术率58.3%,两者有显著差异(P=0.013);在不同术式中,胆肠Roux-en-Y吻合术的再手术率(22.2%)最低;手术的40例中,失访5例,35例得到随访,平均随访时间4.1年(2个月-14年),效果优良率达到97%。结论术中经验不足或过于自信是造成胆管损伤的重要原因;手术时机对于手术的效果有重要的影响,早期发现、早期处理可取得良好的效果。Objective To analyze the cause, clinical characteristics, diagnosis method and the experience of treatment of iatrogenic bile duct injury. Methods Clinical data of 41 patients with the iatrogenic bile duct injury in 14 years were retrospectively analyzed. Results Except one patient died in initial operation, the other 40 cases were repaired by different operative methods. Among these patients, 16 cases were immediately discovered and repaired at the time of the initial operation; the re - operation rate was 18.8% in these 16 cases. For the 24 cases in which bile duct injury was detected after the initial operation, 12 cases were re - operated, and the re - operation rate was 58.3% ; in the whole series, 35 patients were followed up. The excellent result rate was 97%. Conclusion Lack of operation experience and excessive self- centeredness can increase the risk of injury. The key to improvement of treatment result of the iatrogenic bile duct injury is operative time, early diagnosis and early repair of bile duct.

关 键 词：医源性损伤 胆管损伤 诊断 手术方式 

分 类 号：R657.4[医药卫生—外科学]