摘要
目的探讨胆囊切除术中胆管损伤的预防和防治方法。方法回顾性分析27例开腹胆囊切除术致胆管损伤的临床资料。结果27例医源性胆管损伤,均行再手术治愈。单纯缝线拆除3例;胆管壁缺损修复,T管引流4例;胆管端端吻合术加T管支撑引流3例;胆总管或肝总管空肠Roux-en-Y吻合16例;左肝管撕裂原位修补并置U管支撑引流1例;胆总管十二指肠吻合术(CD)2例;1例肝门部胆管损伤作左右肝管切开整形、大口径肝胆管空肠Roux-en-Y吻合术。其中3例两次手术,1例CD效果差改Roux-en-Y;2例为胆管壁缺损修复,T管引流效果差,改Roux-en-Y。26例获随访,优良率88.8%。结论胆囊切除术是胆管损伤的主要原因,但可以预防,术中胆道造影可以减少或避免胆道损伤,胆管空肠Roux-en-Y吻合是胆管损伤修复重建的首选方法。
Objective: To investigate the preventive measures and treatment of bile duct injury during open cholecystectomy. Methods: The clinical materials of 27 cases suffered from bile duct injury during open cholecystectomy were retropectively analyzed. Results: 27 cases of iatrogenic bile duct injury were completely healed by further opration, including simple removing of suture in 3 cases, repairing of bile duct defect with T-tube drainage in 4 cases, end-to-end choleedochocholed ochostomy with T-tube drainage in 3 cases, choledochojejunal Roux-en-Y anastomosis in 16 cases, left hepatic duct repairing with U-tube drainage in 1 case, choledochoduodenostomy in 2 cases, hilar reconstruction with hepatojejunal Roux-en-Y anastomsosis in 1 cases. 26 patients were followed up and 88% of them had good results. Conclusions: cholecystectomy is a leading cause of iatrogenic dile duct injury which can be prevented and avoided when intraoperative cholangiography is applied to. The choledochojejunal Roux-en-Y anastomosis is the initial operative mode to repair and reconstruct the injured bile duct.
出处
《中国现代医学杂志》
CAS
CSCD
2004年第16期93-95,共3页
China Journal of Modern Medicine
关键词
胆囊切除
胆管损伤
防治
探讨
cholecystectomy
bile duct injury
prevention and treatment
discussion
