医源性胆管损伤16例早期诊治分析  

Early diagnosis and treatment of 16 cases with iatrogenic bile duct injury

作　　者：陈圣开[1] 何世举[1] 

机构地区：[1]重庆市第三人民医院肝胆外科,重庆400014

出　　处：《重庆医科大学学报》2010年第5期792-795,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨医源性胆管损伤的早期诊断与治疗。方法:回顾性分析我院1997年7月至2009年9月16例医源性胆管损伤的有关临床资料。胆管损伤按Bismuth分型:Ⅰ型5例,Ⅱ型9例,Ⅲ型0例,Ⅳ型2例,Ⅴ型0例。治疗措施:胆管空肠Roux-en Y吻合加胆管内支撑引流6例,胆管缝合未置T管内支撑引流2例,胆管缝合置T管内支撑引流3例,用脐静脉修补置T管内支撑引流1例,用胆囊管修补置T管内支撑引流2例,单纯腹腔引流2例。结果:随访3月～12年。效果优良11例,占68.8%(11/16);效果差5例,占31.2%(5/16)。结论:医源性胆管损伤早期发现和适当治疗效果较好,延迟发现和治疗不当效果较差。胆管缝合修补置T管内支撑引流和胆肠Roux-en Y吻合加胆管内支撑引流是疗效较好的早期治疗方式。Objective：To explore the early diagnosis and treatment of iatrogenic bile duct injury.Methods：The clinical data of 16 patients with iatrogenic bile duct injury from July 1997 to September 2009 were analyzed retrospectively.The clinical types of the bile duct injuries：BismuthⅠ（5 cases）,BismuthⅡ（9 cases）,Bismuth Ⅲ（0 case）,Bismuth Ⅳ（2 cases）,BismuthⅤ（0 case）.The treatment of the bile duct injuries：Roux-enY biliary-enteric anastomosis with stent tube drainage（6 cases）,bile duct suture without T tube drainage（2 cases）,bile duct suture with T tube drainage（3 cases）,bile duct repair utilizing umbilical vein with T tube drainage（1 case）,bile duct repair utilizing cystic duct with T tube drainage（2 cases）,single drainage of abdominal cavity（2 cases）.Results：All patients had been followed up for 3 months to 12 years.11（68.8%,11/16）cases obtained better effect,while the other 5（31.2%,5/16）cases received second operation because of unsatisfactory effect.Conclusion：Early diagnosis and correct treatment of iatrogenic bile duct injury are necessary for better effect.Otherwise,the effect will be unsatisfactory.Both bile duct suture or repair with T tube drainage and Roux-en Y biliary-enteric anastomosis with stent tube drainage are better treatment in the early stage of iatrogenic bile duct injury.

关 键 词：医源性胆管损伤 诊断 治疗 

分 类 号：R619.5[医药卫生—外科学]