应用循证医学理念处置小切口胆囊切除术中医源性胆管损伤  

Applying evidence-based medicine idea to treat iatrogenic bile duct injury in small incision cholecystectomy

作　　者：王坚[1] 郝立校[1] 蔡珍福[1] 顾树南[2] 皋岚雅[1] 焦成文[1] 刘存官[1] 张大治[1] 吴健健[1] 陈晓军[1] 

机构地区：[1]解放军第455医院肝胆外科,上海200052 [2]兰州军区总医院普外科,甘肃兰州730050

出　　处：《肝胆胰外科杂志》2014年第1期23-25,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨小切口胆囊切除术中医源性胆管损伤的预防及处理措施。方法回顾性分析1991年1月至2010年12月间我院45 306例小切口胆囊切除术的年医源性胆管损伤数量、比率及阶段性比率差异变化。结果 20年来共发生医源性胆管损伤32例,平均发生率为0.071%,低于大宗病例发生率的下限(1%);尤其是后10年的损伤率更趋下降,为0.026%,与前10年相比有统计学差异(P<0.05)。结论小切口胆囊切除术是传统开腹式胆囊切除术在技术上和方法上的一个大的改进和发展,预防医源性胆管损伤至关重要,具有特殊意义。术者只要做到思想重视、规范操作,可以减少胆管损伤或将严重胆管损伤降低到最低限度。Objective To explore and discuss the prevention and treatment of iatrogenic bile duct injury in small incision cholecystectomy. Methods Retrospective and statistical analyses of 45 306 cases were conducted in our hospital from Jan. 1991 to Dec. 2012 with respect to the quantity, proportion, and phased proportion variation of iatrogenic bile duct injuries. Results The iatrogenic bile duct injury occurred in 32 patients during past 20 years, with an average incidence rate being 0.071%, which was less than the lower bound of the incidence rate among those bulk cases. The injury rate was further lowered to 0.026% in the latter 10 years, which was significantly different from the rate in the prior 10 years （P〈0.05）. Conclusion Small incision cholecystectomy is a great improvement and development on traditional open cholecystectomy in terms of techniques and methods. It is particularly important to prevent iatrogenic bile duct injury. Surgeons＇ awareness and standardization of the operation will lower the incidence rate of bile duct injuries or minimize the impact of serious bile duct injuries.

关 键 词：小切口 胆囊切除术 胆管损伤 

分 类 号：R657.4[医药卫生—外科学]