医源性胆管损伤修复的时机及修复失败后的处理体会(附53例)  

Experience of surgical timing for iatrogenic injury of bile duct and the treatment after failing repair ( 53 cases reports)

作　　者：邵成颂[1] 黄强[1] 刘臣海[1] 王成[1] 胡元国[1] 

机构地区：[1]安徽省立医院普外科胆胰病区,合肥230001

出　　处：《肝胆外科杂志》2013年第3期189-191,共3页Journal of Hepatobiliary Surgery

基　　金：安徽省科技攻关计划面上项目(项目编号:08010302189)

摘　　要：目的探讨医源性胆管损伤修复时间的选择和修复失败后的处理体会。方法回顾性分析和总结2004年1月～2011年12月我科收治的53例医源性胆管损伤及损伤修复后再狭窄的病例资料。结果 31例为首次修复,22例为修复后再狭窄病例,6例胆漏型病例行分期手术,21例梗阻型病例一期行胆管-空肠Roux-en-Y吻合,且损伤后10天内修复者手术时间长于十天后修复者,修复再狭窄病例分析,狭窄与首次修复时间选择无关,均再行胆管-空肠Roux-en-Y吻合,术后随访48例,2例术后一年出现吻合口狭窄。结论修复时间不是胆管损伤后修复失败的原因,对于单纯梗阻型胆管损伤,10天后进行修复手术难度下降,修复的最佳方式为胆管-空肠Roux-en-Y吻合术。Objective To explore experience of surgical timing for iatrogenic injury of bile duct and the treatment after failing repair. Methods The clinical data of 53 patients with iatrogenic injury of bile duct and occurred stricture after failing repair referred to our hospital from January in 2004 to Dec in 2010 were analyzed and summarized retrospectively. Results Among cases, 31 were initial repaired, 22 were occurred stricture after repairing. 6 patients were repaired by staging construction for the type of biliary fistula and 21 patients were repaired by Roux-en-Y bile duct-jejunostomy for the type of obstruction. The Operation time which repaired within ten days was longer than 10 days after. In analysis of occurred stricture cases, that is not related with the choice of first surgical timing. All patients were repaired by Roux-en-Y bile duct-jejunostomy again. 48 patients were followed up, 2 cases occurred anastomotic stenosis after a year. Conclusion ： The choice of repairing time is not accounted for failure of repairing biliary after bile duct injury. For the type of obstruction of bile duct injury, the operation is easier after l0 days and the Roux-en-Y bile duct-jejunostomy is the best surgical procedures.

关 键 词：医源性损伤 胆道 外科治疗 

分 类 号：R657.4[医药卫生—外科学]