胆管损伤十二例分析  

Retrospective analysis of 12 cases of bile duct injury

作　　者：周程[1] 严白莉[2] 龚昭[1] 曾志武[1] 杨光耀[1] 夏辉[1] 朱鹏[1] 苏瑛[1] 

机构地区：[1]武汉市第一医院肝胆外科,武汉430022 [2]武汉市第一医院疼痛科,武汉430022

出　　处：《腹部外科》2017年第3期192-196,201,共6页Journal of Abdominal Surgery

基　　金：湖北省自然科学基金(2014CFC1039);2012年武汉市人社局回国留学人员择优资助项目

摘　　要：目的胆管损伤是腹腔镜胆囊切除术最为严重的并发症。最佳的胆道修复措施仍存在争议。本研究旨在评估在武汉市第一医院肝胆专科其术中胆管损伤的发生、修复处理及预后情况。方法单中心回顾性分析2012年1月至2015年12月胆道手术病例3 126例,对12例胆管损伤病例的人群分布、疾病原因、损伤类型、修复方式、中转率、术后并发症、预后结果、医疗纠纷等因素进行分析。结果在3 126例胆道手术中,胆管损伤的总体发生率为0.38%,而腹腔镜胆囊切除术中Strasberg A型以上的损伤率仅为0.17%;依照Strasberg分类,其中A型5例(41.7%),D型3例(25.0%),E1型1例(8.3%),E2型3例(25.0%),均未合并血管损伤。12例胆管损伤主要的疾病性原因为Mirizzi综合征(25.0%)、炎症水肿(25.0%)、迷走胆管(25.0%)和胆囊萎缩(16.7%)。腔镜下简单处理(凝闭、套扎、夹闭或缝闭)6例,中转开腹处理6例(50.0%),其中一期缝合1例、脐静脉修补1例、胆管端端吻合2例、Roux-en-Y肝管空肠吻合2例。术后并发症3例(25.0%),其中DindoClavien分级,2级1例(胆漏)、3a级1例(胆漏并后期狭窄),5级1例(死亡)。胆管损伤处理总体成功率为83.3%,医疗投诉纠纷率为16.7%。结论凭借专科经验的累积,胆管损伤的发生率是可以控制在较低水平的。正确地辨识高危因素、胆道修复医师的专业经验、合理的外科决策对于提高胆道修复的成功率、回避医疗纠纷至关重要。Objective Bile duct injuries （BDI） remain the most serious complication of laparo seopic cholecysteetomy. The best strategy for biliary repair is still controversial. This study aimed to review the status regarding to the incidence, repair approach and outcome of intraoperative BDI at a high volume hepatobiliary surgery institute. Methods 3 126 cases of biliary surgery date in the single- institute were collected and studied retrospectively. In 12 cases of BDI,the parameters such as demog- raphy,pathologic reason,types of injury, repair approach, conversion rate, postoperative complication, outcome and medical litigations were analyzed. Results In 3 126 cases of biliary surgery, the total BDI incidence was 0. 38% ,but concerns about the injuries more than Strasberg A type during laparoscopic cholecystectomy were only 0. 17% in our institute. Based on Strasberg Classification System, there were 5 cases for type A （41. 7%） ,3 cases for type B （25.0%）, 1 case for type E1 （8. 3%） and 3 cases of type E2 （25.0%）, without concurrent vascular injury. In all of 12 BDI cases, Mirizzi syndrome （25.0%）, inflammation edema （25.0%）, Luschka duct （25.0%） and scleroatrophic gallbladder （16. 70%） were the leading pathologic reasons. Simple laparoseopic management （including cautery, ligation,clip or suture） was performed on 6 cases, and open solution was chosen in the rest 6 cases （50. 0%）,in which primary suture closure was performed on 1 case, patch with umbilical vein on 1 case,bile duct end to end anastomosis on 2 cases, and Roux-en-Y hepaticojejunostomy on 2 cases re-spectively. Postoperative classification, including 1 complications were case of class 2 （bile and I case of class 5 （death）. Overall success observed in 3 patients, according to the Dindo-Glavien leak）, 1 case of class 3a （bile leak and late constriction）, rate of BDI repair was 83. 3% with 16. 7% of medical litigation incidence. Conclusions With the accumulation of biliary surgical experience, it is possi

关 键 词：胆管损伤 腹腔镜胆囊切除术 胆道重建 

分 类 号：R657.4[医药卫生—外科学]