摘要
目的探讨医源性胆道损伤(IBDI)的诊断、治疗及预防方法。方法回顾性分析我院1990年4月至2008年3月收治的胆囊切除致胆道损伤患者的临床资料。结果192例(76.8%)患者获得随访,随访时间2个月至12年,平均3年4个月,无因手术死亡报告。162例(84.38%)术后效果满意,13例(6.8%)肝功能轻度异常,4例(2.1%)并发胆管炎症,相关对症处理治愈。4例Roux-en-y胆肠吻合术后胆道吻合口狭窄,再次行肝胆管盆式Roux-en-y吻合术或吻合口整形,术后恢复良好。结论充分辨清胆囊管与胆总管的汇合以及肝管局部关系,是预防IBDI的关键,继而根据损伤类型及病理确定恰当手术时机与术式。
Objective To investigate the diagnosis, management and prevention of iatrogenic bile duct injury （IBDI） following cholecystectomy. Methods A retrospective study was conducted in 250 cases of IBDI following cholecystectomy during April 1990 and March 2008 in our hospital. Results 192 patients（76. 8% ） were followed up for 2 months -12 years （3 years and 4 months on average）. There was no operation-related death. 162 cases（84. 38% ） achieved satisfactory outcome after operation. Slightly abnormal liver function was found in 13 cases（6. 8% ） , and cholangitis in 4 cases（2. 1% ） but cured after treat- ment. Anastomotic stenosis of the bile duct after Roux-en-y choloenteronastomosis occurred in 4 cases and all of them recovered well after second Roux-en-y choloenteronastomosis. Conclusion The key point to prevention of IBDI from cholecystectomy lies in abiding by the principle of ＂identifying-cutting-identifying＂ during cholecystectomy, and identifying clearly the local anatomy between the duct of gallbladder, bile commen duct and hepatic duct. Surgeons decide the timing and mode of operation properly according to the category and.the pathology of IBDI.
出处
《实用医院临床杂志》
2008年第6期96-97,共2页
Practical Journal of Clinical Medicine
关键词
胆道损伤
胆囊切除术
医源性疾病
Bile duct injury
Cholecystectomy
Iatrogenic disease
