胆囊切除术胆道损伤20例的Strasberg分型、处理与预后.pdfVIP

· 346 · 腹部外科 1U年第23卷第6期 FuBuWaiKe，Dec．2010，v_01．23，No．6 胆囊切除术胆道损伤 20例的Strasberg分型、 处理与预后 陈祖兵 沈世强 丁佑铭 邬善敏 张爱民 王卫星 【摘要】 目的 探讨胆囊切除术致胆道损伤的Strasberg分型、处理与预后的关系。方法 回顾 性分析近8年间收治的胆囊切除术后胆道损伤病人的临床资料和Strasberg分型。结果 按胆道损 伤 Strasberg分型标准，0例中A型7例，非手术治疗有效，恢复良好 ；D型4例，均为术中发现 ，行胆 管修补，随访良好；E1型1例 ，术后外引流，3个月后择期行胆肠吻合术 ，随访良好；E2型2例，术中发 现 ，行胆肠吻合术，随访 良好；E3型3例，其中1例术中行肝胆管空肠吻合术，随访 良好 ，另 2例3个 月后择期行胆肠吻合术，1例恢复不 良；E4型3例，均择期行胆肠吻合，1例恢复不 良。结论 胆囊切 除术致胆道损伤疗效取决于损伤的类型，术中、术后正确处理 ，以及专科医生参与。 【关键词】 胆囊切除术；胆道；手术中并发症 ；Strasberg分型 Strasbergclassification，treatmentandprognos~forbileductinjuryfollowingcholecystectomy CHEN Zwbing，SHEN Shi—qiang，DINGYou-ming，eta1．DepartmentofSurgery，RenminHospitalof WuhanUniversity，Wuhan 430060，China Correspondingauthor：SHEN Shi—qiang，E-mail：swsw2218@hotmail．coin [Abstract] Objective ToexploretheStrasbergtypeandtreatmentofbileductinjury(BDI)f01— 1owingcholecystectomy．Methods Clinicaldataof20casesofBDIfollowingcholecystectomywerean— alyzedretrospectively．Results ForStraberg classification，therewere7casesoftypeA ，4 casesof typeD，onecaseoftypeE1，2casesoftypeE2，3casesoftypeE3，and3casesoftypeFA．Patients withBDIoftypeA werecuredafterdrainage．PatientswithBDIoftypeDreceived “immediaterepair’’ andcured．OnewithBDIoftypeE1received “electiverepair”，cholangioenteroticanastomosis。and cured．TwowithBDIoftypeE2received “immediaterepair”。cholangioenteroticanastomosis．and cured．Of3casesofBDIoftypeE3BDI，onereceived “immediaterepair”，cholangioenteroticanasto— mosis，andcured；tworeceivedelectivecholangioenteroticanastomosis，onecuredandonedeveloped eholangiotitis．ThreewithBDIoftypeFA receivedelectivecholangioenteroticanastomosis．twocured andonedevelopedcholangiotitis．Conclusion Theoptimalmanagementdependsonthetimingofrec— ognitionofinjury，theextentofBDI，thepatientsconditionandtheavailabilityofexperiencedhepato— biliarysurgeons． [Keywords] Cholecystectomy；Biliarytract；Intraoperativecomplications；Strasberg’Sclassifica— tion