医源性胆道损伤的预防及处理

目的 探讨医源性胆道损伤的原因、预防及处理方法。方法 对1990年1月至2005年10月南雄市人民医院和北京军区总医院收治的31例医源性胆道损伤的临床资料进行回顾性分析。结果开腹胆囊切除、胆总管探查及腹腔镜胆囊切除是医源性胆道损伤的主要原因，占87．1％（27／31）。31例均行手术治疗，共行胆道重建修复手术41例次，其中行2次手术5例，3次以上（含3次）3例。29例随访3个月至7年。疗效优良率达82．8％。结论医源性胆道损伤常见于胆囊切除术。熟悉胆道解剖及变异、严格掌握手术指征、术中肝外三管的辨认是预防医源性胆道损伤的关键。根据损伤的时间及类型采取相应的处理方法，早期发现和及时正确的处理对预后十分重要，胆管空肠Roux—en—Y内引流术是目前最常用且疗效肯定的胆道重建方法。

Iatrogenic bile duct injury:prevention and management

Objective To investigate the causes,prevention and management of iatrogenic bile duct injury.Methods The clinical data of 31 patients with iatrogenic bile duct treated from January 1990 to December 2005 were analyzed retrospectively.Results The main causes for iatrogenic bile duct injury were open cholecystectomy,common bile duct exploration and laparoscopic cholecystectomy, which accounted for 87.1% (27/31).Forty-one bile duct reconstruction operations were performed in 31 patients.Among 31 patients,29 patients were followed up for 3 months to 7 years and the rate of satisfactory outcome was 82.8%.Conclusion Iatrogenic bile duct injury often occurs during cholecystectomy.Good knowledge of the anatomy and the possible variations of the bile ducts, strictly controlling of operative indications and recognition of bile cyst,common hepatic duct and common bile duct are the keys to prevent iatrogenic bile duct injury.Management according to the time and types of bile duct injury,early finding and timely correct management are very important to the prognosis.Roux-en-Y biliary-enteric anastomosis is the commonest and the most effective method for the bile duct reconstruction.