摘要
目的 :探讨医源性胆管损伤修复后再手术的原因及防治 .方法 :对 2 0a中 12 9例医源性胆管损伤 ,12 0例修复后10 8例再手术患者 ,损伤部位和修复时机进行回顾性分析 .结果 :再手术率 90 %(10 8/ 12 0 ) ;再手术率与患者性别、年龄无显著关系 ;再手术率与损伤原因、损伤部位、修复时机、手术方式和手术操作等因素有关 ;腹腔镜胆囊切除术 (LC)胆管损伤修复后再手术率最高 (10 0 %) ,开腹胆囊切除术 (OC)次之(91 3 0 %)、OC +胆管探查术最低 (71 4 3 %) ,三组间相差显著 (P <0 0 5 ) ;损伤部位再手术率 :肝总管、肝门部胆管、高位胆管分别为 92 3 1%,91 67%,94 5 2 %三者无显著差异 ,而胆总管损伤再手术率最低 5 5 5 6%,与前三个部位再手术率相差非常显著 (P <0 0 1) .结论 :胆管损伤力争手术中、术后早期 (<4 8h)确诊并修复 ,短期内 (<4wk)修复应慎用 ,4wk后行近端胆管与空肠Roux y端侧 侧吻合较合适 ,并内置T管支撑 6mo以上 ,可降低术后胆管狭窄及返流性胆管炎的发生率 ,从而降低再手术率 。
AIM: To discuss the causes and prevention of re-operation of iatrogenic bile duct after first reparative operation. METHODS: 129 cases of iatrogenic bile duct damage within the past 20 years were reviewed and analyzed. Of the 129 cases, 120 cases underwent two operations and 108 cases underwent three operations. RESULTS: The third operation rate (90%, 108/120) was related with the causes of damage, damage sites, types of the first operation and second reparation time, but was not related with sex and age. Damage rates of laparoscopy, open abdominal operation and cholecystectomy with exploration of common bile duct were 100%, 91 30% and 71 43% respectively. Damage rates of common hepatic duct, porta hepatic duct, high bile duct and common bile duct were 94 52%, 91 67%, 92 31% and 55 56% respectively. CONCLUSION: Iatrogenic damage of bile duct should be diagnozed and repaired within 48 hours. Bile duct repair operation is not suggested within 4 weeks. Roux-y cholangio-jejunostomy is the best management for iatrogenic damage of bile duct after 4 weeks. Inter-bile drainage should also be kept for at least half a year to reduce the rate of cholangitis and to promote the efficacy of the operation.
出处
《第四军医大学学报》
北大核心
2003年第8期751-753,共3页
Journal of the Fourth Military Medical University
关键词
医原性疾病
胆管/损伤
再手术
Iatrogenic disease
bile ducts/injuries
re operation
