临床外科杂志 ›› 2018, Vol. 26 ›› Issue (10): 777-779.doi: 10.3969/j.issn.10056483.2018.10.018

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医源性胆道损伤13例诊治分析

  

  1.   441400  湖北襄阳,湖北省宜城市人民医院普外科(刘明新);武汉市华中科技大学同济医学院附属协和医院肝胆外科(徐剑军)
  • 收稿日期:2018-04-23 出版日期:2018-10-20 发布日期:2018-10-20
  • 通讯作者: 徐剑军,Email:m201675623@hust.edu.cn

Analysis of causes and treatment of iatrogenic bile duct injury

  1.   Department of General Surgery,People's Hospital of Yicheng,Xiangyang,Yicheng 441400,China
  • Received:2018-04-23 Online:2018-10-20 Published:2018-10-20

摘要: 目的  总结医源性胆道损伤的原因及处理方法。方法  回顾分析13例胆道损伤病人的病历资料,归纳胆道损伤的原因、损伤部位、临床分型并总结治疗经验。结果  损伤原因:13例病人中2例为副右肝管被误切,7例为胆囊三角解剖不清致胆管误伤,2例为胆管电灼伤穿孔,1例为过分牵拉致胆总管夹闭,1例为生物胶粘连压迫。治疗方法:4例行胆管间断缝合和T管引流,5例行胆管端端吻合和T管引流,4例行胆肠RouxenY吻合术。除1例D级愈合,治疗失败再次手术外,其余12例均在初次手术治疗成功。结论  胆管损伤多由于解剖不清和操作粗暴造成,损伤部位多位于胆总管中上部;胆肠RouxenY吻合术是安全有效的手术方法。术中预防才是避免胆道损伤的根本途径。

Abstract: Objective    To investigate the causes and explore effective treatments of iatrogenic bile duct injury(IBDI).Methods   Clinical data of 13 iatrogenic bile duct injury patients,who were analyzed to summarize the causes of bile duct injury and the experience of treatments.  Results  Among the 13 cases with IBID,2 cases were accessory right hepatic duct injury,7 cases were due to confused anatomic dissection of the gallbladder triangle,2 cases were caused by electric cauterization,common bile duct of 1 case was clamped due to excessive traction,and 1 injury was caused by adhesion and compression of biologic adhesive.For the treatments,4 patients received intermittent suture of bile duct plus T tube drainage,5 patients received bile duct endtoend anastomosis plus T tube drainage,and 4patients were treated by RouxenY biliaryenteric anastomosis.Except for one case of failure,the other 12 cases were successfully cured in the initial repair operation.Conclusion  IBDI was often caused by unclear anatomy and rough operation.Most of the lesions locate in the upper and middle part of the common bile duct.The RouxenY anastomosis is a safe and effective surgical procedure for IBID treatment.More importantly,prevention is the basic way to avoid IBID.


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