围手术处理因素对胆道损伤的预后影响  

Effect of perioperative management on prognosis of bile duct injury

作　　者：王旭[1] 孙建明[1] 唐彤[1] 王翔翔[1] 刘明忠[1] 赵宇[1] 

机构地区：[1]四川省达州市中心医院肝胆外科中心,635000

出　　处：《中华肝胆外科杂志》2009年第1期14-16,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨围手术因素在处理胆道损伤时的重要辅助影响。方法分析收集四川省达州市中心医院自1987-2006年收治处理的66例胆道损伤病人的临床资料，结合随访结果．总结非手术因素对处理胆道损伤的重要预后影响。结果48例经B超、CT、MRCP、ERCP等影像学检查证实。术中发现胆道损伤经影像学等方法准确诊断后直即施行修复或吻合手术者44例，9例凶损伤后时间较长或病情较覃．经有效外引流、支持抗感染等非手术措施治疗在3～6个月后获得二期胆道重建术手术机会。2例死于胆漏抽致的全腹膜炎及全身衰竭。1例因十二指肠大小乳头开口于憩室内在切除憩室后致胆胰管损伤行胆肠、胰肠吻合术后死于并发症：3例胆道吻合术后出现吻合口狭窄经球囊扩张治疗近期症状明显缓解。1例胆肠吻合病人因反复发生胆管炎在多次手术后死于全身衰竭。结论除厂手术治疗之外，胆道损伤后的围手术期处理对于胆道损伤后预后有着重要影响。胆道损伤宜及时发现并处理。术中胆道造影可增加诊断正确率并对选择处理方式有重要指导作用．对于合并有严重腹腔感染者，应在良好引流、全身支持、控制感染后择期手术。支撑管的恰当放置和胆道扩张器对降低狭窄率仍有一定作用。Objective To investigate the important auxiliary effect of perioperative management on bile duct injury. Methods The clinical and follow up data of 66 patients with bile duct injury treated in our hospital during 1987 2006 were analyzed to explore the effect of perioperative management on the prognosis of the bile duct injury. Results The bile duct injury in 48 cases was proved by Bus, CT, MRCP. ERCP or other imaging w_etbods. The injury in 44 cases was found during operation by imaging methods and were timelyanastomosed or repaired. Nine cases obtained the opportunity for the second-stage bile duct reconstruction after treatments of effective external drainage, general support and anti infection treatment for 3-6 months. Two patients died of diffuse biliary peritonitis or systemic failure, 1 died of pancreatoieiunal or choledochojejunal anaslomotic syndrome because the major duode- nal papilla and minor duodenal papilla was located in diverticulum after the diverticulum was excised. Bile duct stenosis happened after cholangiojejunostomy and the syndrome was obviously alleviated recently by ballon dilatation therapy. One post cholangiojejunostomy patient died of systemic failure after repeated attack cholangitis and reiterative operations. Conclusion In addition to operative treatment, perioperative management is a very important factor to affect the prognosis of the bile duct inju ry. Bile duct injury should be found and disposed in time. Intraoperative cholangiography could increase the diagnostic accuracy and play an important guiding role in selecting treatment methods. For the cases with eritical abdominal infection, it should be operated in proper time after effective drain age, general support and infection control. Proper placing of the support tube and the application of bile duct dilator are crucial for decreasing the ratio of biliary duct stricture.

关 键 词：胆道损伤 围于术处理 预后 

分 类 号：R686[医药卫生—骨科学]