医源性胆管损伤治疗时机与术式选择

医源性胆管损伤约90%发生于胆囊切除术。根据发现时间、部位和类型，采取不同的治疗方法。术中发现即时修复最为理想，成功率高，远期效果好；术后胆漏引流通畅，多主张观察后期处理；胆汁性腹膜炎应紧急开腹手术，行胆管及腹腔引流术，后期行胆管修复治疗；梗阻性黄疸多主张观察治疗，待胆管扩张直径≥15mm，再行胆管修复手术。后期发生的胆管瘢痕性狭窄和术后胆管或吻合口狭窄，根据具体情况选择内镜、介入或手术治疗。胆管修复的最佳方案是既能恢复胆道的连续性，又保存了Oddi括约肌功能，如带血管蒂的组织瓣移植、胆管对端吻合术等。对于不适合上述方法治疗的病例，胆管空肠Roux-en-Y吻合术是常用和有效的方法。

Treatment time and surgical method option in iatrogenic bile duct injury

About 90% of iatrogenic bile duct injury is caused by cholecystectomy.Different treatment methods should be adopted according to finding time,the location and type.If it is found during operation and repaired immediately,the success rate is high and the long-term effect is good.If the drainage of postoperative bile leakage is smooth,condition changes should be observed for the further treatment.Patients with bile peritonitis need laparotomy.Bile duct and abdominal cavity drainage are usually performed at fi...