医源性胆管损伤16例治疗分析  

Treatment of iatrogenic bile duct injury： A report of 16 cases

作　　者：李留峥 向春明 徐雷升 彭联芳 俸家伟 王志萍 赵海荣 于杰 

机构地区：[1]临沧市人民医院肝胆外科,云南临沧677000

出　　处：《腹部外科》2015年第6期434-436,共3页Journal of Abdominal Surgery

基　　金：云南省中青年学科带头人后备人才培养基金资助（2006PY01-63）;临沧市科技计划（2015NS04）

摘　　要：目的总结医源性胆管损伤的治疗经验。方法回顾性分析2005-2014年收治的16例医源性胆管损伤病人的临床资料。男性7例，女性9例，年龄25-67岁，中位年龄42．4岁。16例术前行B超检查，3例行CT检查，均为胆囊结石或胆囊息肉，1例合并胆管炎，病史2个月至11年。开腹胆囊切除术（OC）6例，腹腔镜胆囊切除术（LC）9例，胆道探查术1例。对诊断和治疗方法进行总结分析。结果16例医源性胆管损伤中，开腹胆囊切除术6例，腹腔镜胆囊切除术9例，胆道探查术1例。术中诊断胆管损伤5例，术后诊断胆管损伤11例。2例迷走胆管损伤，经结扎迷走胆管，行鼻胆管及腹腔引流痊愈。14例再次手术治疗，其中胆总管损伤范围3～5mm，行胆总管修补＋T管引流2例，胆总管横断行端端吻合2例，迷走胆管缝扎、胆总管切开探查＋T管引流2例，肝总管（或右副肝管）横断，行肝总管（或右副肝管）空肠Roux-en-Y吻合8例。其中3例胆管损伤后行2次以上手术。结论重视胆道系统的解剖与变异，加强责任心，规范胆道手术操作，是防止胆管损伤的主要措施。Objective To summarize the experiences of managing iatrogemc bile duct injury. Methods The clinical data of 16 cases of iatrogenic bile duct injury from 2005 to 2014 were retrospectively analyzed. The methods of diagnosis and treatment were analyzed. Results The procedures included open cholecystectomy （n = 6）, laparoscopic cholecystectomy （n = 9） and common bile duct ex- ploration （n= 1）. Intraoperative （n= 5） and postoperative （n = 11） diagnoses of bile duct injury were made. Two cases of aberrant duct injury were cured by ligation of aberrant duct and endoscopic nasobiliary and abdominal drainage. Among 14 reoperative cases, common bile duct injury of 3 - 5 mm occurred. The procedures included common bile duct repair plus T tube drainage （n = 2）, bile duct end- to-end anastomosis （n = 2）, aberrant duct suturing ligation of common bile duct exploration plus T tube drainage （n = 2） and hepatic duct （or right accessory hepatic duct） transection ＆ hepatic duct （or right accessory hepatic duet） jejunum Roux-yanastomosis （n = 8）. Three cases of bile duct injury were re-operated more than twice. Conclusions Highlighting the importance of anatomy and variation of biliary system, enhancing the sense of responsibility and standardizing biliary tract procedures are key measures of preventing bile duet injury.

关 键 词：医源性 胆管损伤 外科 

分 类 号：R657.4[医药卫生—外科学]