胃胆管治疗医源性胆管损伤的体会  

Experiences of gastro-bile duct drainage in treating iatrogentic injury in the bile duct.

作　　者：周鹏[1] 郭子健[1] 戴赛民[1] 张勇[1] 周俊晶[1] 

机构地区：[1]苏州大学附属第四医院肝胆外科,无锡214062

出　　处：《中国综合临床》2009年第11期1188-1189,共2页Clinical Medicine of China

摘　　要：目的探讨医源性胆管损伤的原因及应用胃胆管的治疗效果。方法回顾性分析9例医源性胆管损伤患者的临床资料。结果9例患者的胆管损伤均在术中及时发现。5例系金属探条暴力所致，2例取石钳损伤，1例腹腔镜分离钳损伤，1例肝总管横断。经注水试验、胆管造影或胆道镜检查证实后，即在胆总管内置入细硅胶管（胃胆管）经十二指肠乳头、幽门、胃前壁引出固定于腹壁，胃胆管头端固定有自制弹力圈以防自胆管脱出。常规于胆管损伤处或后腹膜胆总管损伤处置引流管。9例患者均恢复顺利，8例胃胆管引流6～10d后拔除，1例30d后拔除，随访9个月至5年，未出现胆管狭窄、腹膜后感染等并发症。结论术中胆道镜、胆管注水试验和术中胆管造影有助于诊断；胃胆管引流对胆管损伤有一定应用价值，但临床应用例数太少，有待进一步积累资料和观察。Objective To study the effect of applying gastro-bile duct drainage in iatrogentic injury in the bile duct and reasons of iatrogentic injury in the bile duct. Methods Clinical data of 9 cases with iatrogentic injury in the bile duct were studied retrospectively. Results Nine patients with iatrogentic injury in the bile duct were found in time by affusion examinatian,eholedochoendoseopy or cholangiography intraoperation,including 5 cases injured by metal divining rod,2 cases caused by lithotomy, 1 case injured by laparoscopic elastic separating plier and 1 case injured by common hepatic duct transection. The gastro-bile duct was placed into common bile duct through pa- pilla of duodenum, pylorus and the former wall of gastric. All the cases recovered smoothly. The gastro-bile duct was removed in 8 cases in 6 to 10 days later,in 1 eases in 30 days later,who were followed up for 9 months to 5 years, finding no complications such as stricture of bile duct and retroperitoneal infection. Conclusions Intraoperative choledochoendoscopy, affusion examination and eholangiography are helpful to diagnosis. The better results are achieved by appling gastro-bile duct drainage in iatrogentic injury in the bile duct.

关 键 词：医源性胆管损伤 诊断 治疗 

分 类 号：R657.4[医药卫生—外科学] R644[医药卫生—临床医学]