摘要
目的 提高医源性胆管损伤的诊断及防治水平。方法 回顾近12年医源性胆管损伤28例 ,分析早期诊断、处理方法和治疗效果。结果 术中发现5例胆管损伤立即修复 ,均治愈。术后发现的胆管损伤则采用不同的方法及早处理。对胆漏先行胆道及腹腔引流 ,3～6个月后再作胆道重建术 ;对胆管梗阻不伴感染者 ,6例1周内行胆道重建 ,术后1～4年内均发生吻合口狭窄 ,9例3～4周后 (胆管扩张≥1.5cm)行胆道重建 ,随访2～4年 ,无吻合口狭窄发生。结论 术者直视下仔细操作、解剖清楚 ,是预防胆管损伤的关键。胆管损伤应根据损伤具体情况 ,选择不同的方法及时处理。胆管梗阻无感染者 ,待胆管扩张≥1.5cm时 ,再作重建术 。
Objective To improve the diagnosis, prevention and treatment in iatrogenic bile duct injury. Methods It was analyzed that the early diagnosis, management method and treatment effect in 28 cases of the iatrogenic bile duct injury by a retrospective study in last twelve years. Results It was cure in 5 patients, the bile duct injury was recognized and repaired at the initial operation. Patients whose bile duct injury was recognized after operation should be managed by the bile duct and abdominal drainage, and the biliary tract reconstruction was performed after 3～6 months. Among the patients with bile duct obstruction and without infection, the biliary tract reconstruction of 6 patients was performed within the first week, but all patients the anastomotic stenosis were formed in 1～4 years after operation; the biliary tract reconstruction of 9 patients was performed after 3～4 weeks (biliary tract≥1.5cm), no anastomotic stenosis were formed in all patients after operation with 2～4 years follow-up. Conclusion It is key problem in prevention the iatrogenic bile duct injury for operator, to keep guard, to familiar with anatomy, to operated in orthophoria. If the iatrogenic bile duct injury occurred, according to the different information that may be managed as early by different methods. For the patients with bile duct obstruction without infection, the biliary tract reconstruction should be done if the bile duct distended(≥1.5cm), and the anastomotic stenosis would be decreased.
出处
《浙江临床医学》
2002年第4期252-253,共2页
Zhejiang Clinical Medical Journal
