医源性胆管损伤一期修复术式选择及评价  

Selection and evaluation of primary repair of iatrogenic bile duct injury

作　　者：程庆保 刘辰 姜小清 CHENG Qing-bao;LIU Chert;J(No.1 Department of Biliary Surgery,Eastern Hepatobiliary Surgery Hospital,the Second Military Medical University,Shanghai 200438,China)

机构地区：[1]海军军医大学东方肝胆外科医院胆道一科,上海200438

出　　处：《中国实用外科杂志》2018年第9期1003-1006,共4页Chinese Journal of Practical Surgery

摘　　要：随着腹腔镜和机器人手术的逐步开展和普及,医源性胆管损伤的发生率有逐步升高的趋势。外科手术仍然是治疗严重胆管损伤最为确切的治疗手段,然而对于手术时机和修复方案的选择目前国内外争议仍然很大。发现胆管损伤后,应由具备相应技术条件的专科医师详细评估损伤局部和全身情况,尽量一期修复,创伤较小,医患双方也相对容易接受。外科手术修复的目的是恢复胆肠通路的连续性,考虑到损伤大多为横断伤,修复方式主要包括胆管空肠吻合和胆管对端吻合两种方式,根据损伤的局部和全身情况及手术医生的经验和技术选择。胆管损伤目前仍然是胆道外科的一大难题,重点在于预防,术前详细评估,行磁共振胰胆管造影(MRCP)检查明确有无易致胆管损伤的解剖变异非常关键,术中仔细操作,避免胆管损伤的发生。With the gradual development and popularization of laparoscopic and robotic surgery, the incidence of iatrogenic bile duct injury is increasing gradually. Surgery is still the most effective way to treat severe bile duct injury. However, there is still a great deal of disputes about the choice of timing of surgery and the choice of repair methods. After finding the bile duct injury, the local and systemic condition of the injury should be evaluated in detail by the specialist with the corresponding technical condition, and the injury should be repaired earlier as far as possible, because of the trauma is relatively small, and the doctors and patients are relatively easy to accept. The purpose of surgical repair is to restore the continuity of the biliary tract, taking into account that most of the lesions are transverse injury, and the repair methods mainly include choledochojejunostomy and bile duct end-to-end anastomosis, according to the local and systemic conditions of the injury, as well as the experience and technical choice of the surgeon. Iatrogenic bile duct injury is still a difficult problem in bile duct surgery at present. The emphasis should be on prevention. It is very important to evaluate it in detail before operation and make sure whether there is anatomic variation of bile duct injury by MRCP. Careful operation should be can＇ied out during the operation to avoid biliary tract injury.

关 键 词：医源性胆管损伤 修复 胆管对端吻合 胆肠吻 合 

分 类 号：R6[医药卫生—外科学]