摘要
目的 探讨医源性胆道损伤的防治方法。方法 对 1990年 3月～ 2 0 0 0年 9月收治的 118例医源性胆道损伤资料进行回顾性分析。结果 胆囊切除时胆囊三角区解剖不清是医源性胆道损伤发生的主要原因 ,占 5 0 8% (6 0 118)。医源性胆道损伤的诊断主要依赖于临床症状、体征、腹部穿刺和影像学检查 ,其中B超诊断率可达 93 2 % (110 118)。按损伤部位作者将其分为 6个类型 ,临床上以肝总管和胆总管部分切除的损伤类型 (Ⅲ型 )多见 ,占 83 9% (99 118)。根据损伤类型而选择相应的外科手术方式可明显提高治愈率 ,本组治愈率达 10 0 % (118 118)。结论 胆囊切除时遵循“辨、切、辨”三字原则是预防医源性胆道损伤的关键 ,损伤类型则决定手术方式的选择。
Objective To study the experience in prevention and treatment of iatrogenic bile duct trauma(IBDT). Methods A retrospective study was made on the clinical data of 118 patients with iatrogenic bile duct trauma admitted to the Hunan Provincial People's Hospital from March 1990 to September 2000. Results 50.8%(60/118) of patients with IBDT resulted from the wrong identification of the anatomy of the Calot' Triangle during cholecystectomy. The clinical diagnosis of IBDT depended on the clinical findings, diagnostic abdominocentesis and image examination. The diagnostic rate of ultrasonography for IBDT was 93.2%(110/118). According to the injury site of bile duct, IBDT could be divided into 6 types, the most common type of IBDT was resection of partical hepatic duct and part common bile duct(type Ⅲ) which occurred in 83.9%(99/118) of the patients. The cure rate of IBCT was 100%(118/118) in this series due to the choice of operation according to the trauma type. Conclusions The key of prevention to IBDT lies in abiding by the princible of “identifying cut recognazing” during cholecystectomy. The choice for surgical operative procedure should agree with the trauma type.
出处
《中国普通外科杂志》
CAS
CSCD
2001年第1期42-45,共4页
China Journal of General Surgery
关键词
胆道损伤
医源性疾病
胆囊切除术
副作用
BILIARY DUCTS/inj
IATROGENIC DISEASE
CHOLECYSTECTOMY/adv eff
