中国实用外科杂志

中国实用外科杂志 ›› 2006, Vol. 26 ›› Issue (02): 1-82.

• 论著 •    

医源性胆管损伤的紧急处理

高志清，付由池，刘正才   

  1. 第四军医大学西京医院肝胆外科，陕西西安 710032
  • 收稿日期:2005-09-03 修回日期:2005-10-10 出版日期:2006-01-23 发布日期:2006-01-23

Immediate management of iatrogenic bile duct injury.

Gao Zhiqing,Fu Youchi,Liu Zhengcai.   

  1. Department of Hepatobiliary Surgery,Xijing Hospital, Fourth Military Medical University,Xi’an 710032,China
  • Received:2005-09-03 Revised:2005-10-10 Online:2006-01-23 Published:2006-01-23

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摘要：

目的:探讨医源性胆管损伤的处理方法及注意事项。方法:回顾性分析1992年10月至2005年1月西安地区会诊的13例医源性胆管损伤的术中处理方法，以及长期随访的疗效。13例中，男7例，女6例；腹腔镜胆囊切除（LC）9例，开腹胆囊切除（OC）4例。胆管横断伤5例，其中4例对端吻合术；另1例和3例胆管切除一段者，采用高位胆肠吻合术；胆管切除并左右肝管部切除5例，采用肝管Y形空肠“四针缝合法”吻合。结果:随访5个月至13年，无手术死亡，无黄疸及胆道感染等并发症。结论:胆管损伤一旦发生应及时处理，根据术中损伤类型，采取不同的处理方法，可获得满意的效果。

关键词: 医源性胆管损伤, 胆肠吻合术

Abstract:

Objective:To explore the management and cautions of the iatrogenic bile duct injury. Methods:A retrospective study was undertaken to investigate the intraoperative procedure and the effect of longterm followup in 13 patients with iatrogenic bile duct injury in Xi’an’s hospitals from October 1992 to January 2005.In these 13 cases,7 men and 6 women,there were 9 cases following laparoscopic cholecystectomy and 4 cases following open cholecystectomy.In the five bile duct transection,4 were underwent endtoend anastomosis.The other one and 3 duct partial resection were performed superior position cholangiojejunostomy.The 5 patients with bile duct resection and left and right hepatic duct partial resection were treated by RouxenY hepaticojejunostomy with fourneedle suture. Results:Following up form 5 moths to 13 years,there were no dead cases and no complication such as jaundice and infection of biliary tract. Conclusion:Once the bile duct was damaged, surgical repair should be performed immediately.The different approach should be chosen according to injury type to obtain satisfactory effect.

Key words: Iatrogenic bile duct injury, Hepaticojejunostomy