摘要
目的 探讨医源性胆管损伤的原因和治疗。方法 分析 1995～ 2 0 0 1年间收治的 17例医源性胆管损伤病例的致伤原因、手术方法及治疗结果。结果 本组病例初次手术均为胆囊切除术 ,其中 ,腹腔镜胆囊切除 (LC) 7例 ,开腹胆囊切除 10例。手术中发现胆管损伤 11例 ,其中 4例于术中同时行对端吻合术 3例 ,另 1例行右肝管结扎 ,效果满意。手术后发现 6例。其余病人均经再次手术 ,其中采用胆管空肠Roux y吻合 9例、脐静脉修补胆管狭窄 1例、行胆管缝线结扎松解和T形管引流 1例、胆管钛夹取出和T形管引流 2例。结论 医源性肝外胆管损伤是胆囊切除手术的一种常见并发症。只要注意掌握手术原则 ,大多数医源性胆管损伤是可以避免的。手术中发现胆管损伤 ,行对端吻合为宜 ;手术后发现宜行胆管空肠Roux y吻合术 ,大多效果满意。
Objective To investigate the causes and the treatment of iatrogenic biliary tract injury.?Methods A total of 17 analyzed including the causes of injury, the methods of surgical procedures and the results of treatment.?Results In the first operation, the 17 cases were all cholecystectomy including open cholecystectomy in 10 cases and laparoscopic cholecystectomy in 7 cases. Among these patients,biliary tract injury during the operation were found in 11 cases,in which only 3 cases were treated with end end anastomosis and 1 case with right hepatic duct ligation. Good results were obtained in this patient. Re operations were performed on other patients. Six cases iatrogentic biliary tract injury were found after operation. Among all reoperative patients,9 cases were treated with Roux en Y choledochojejunostomy,1 case of biliary tract stricture was repaired by using a segment of umbilical vein,3 cases by loosing up the biliary tract ligature or clip and T tube drainage.?Conclusion Iatrogenic biliary tract injury is a common complication of cholecystectomy. Almost all operative injuries of the biliary tract are preventable if surgical principles were perforned strictly. The results of end end anastomosis are satisfactory to biliary tract injuries found during operation. Choledochojejunostomy is a good surgical method for reoperative patients.
出处
《创伤外科杂志》
2003年第1期6-8,共3页
Journal of Traumatic Surgery
