医源性胆管损伤类型及处理：附64例分析.pdfVIP

主堡萱 [ 皇王 生 箜 鲞笙 塑 in!GenSurg(ElectronicEdition)，Febmary2010，Vol4，No．1 · f临床 结 · 医源性胆管损伤类型及处理：附‘64例分析 雷正明 付文广 叶明新 【摘要 】 目的 探讨医源性胆管损伤分类及处理方法。方法 回顾性分析自1982年1月至2009年 7Yl我科医源性胆管损伤64例临床资料。结果 损伤原因：常规开腹手术 (OC)45例，电视腹腔镜手术 (LC)19例。损伤发现时间：术中发现30例，术后发现34例。损伤部位：胆总管上段至肝总管损伤 占57．8％ (37／64)，胆总管下段损伤12．5％(8146 )，肝管损伤29．7％(196／4)。结论 肝 内胆管损伤主要处理合并 的肝内动脉损伤出血；胆总管下段伴胰腺损伤宜行胰头十二指肠一空肠侧侧吻合；胆总管上段一肝总管 损伤方式多样；腹腔镜手术胆管损伤后无胆漏，解剖清晰可以早期修复。 【关键词】 手术中并发症；外科损伤；医源性胆管损伤；治疗 Classificationandtreatmentforiatrogenicbileductmjury：oneanalyseof64casesLE／Zheng-mingFU Wen-guang,YEMing-xing．HepatobiliarySurguryDepartment,LuzhouMedicalCollegeAffiliatedHospital, Luzhou646000,China Correspondingauthor：LEIZheng-mingEmaikminglei762@sohzacom A【bstract】 Objective ToinvestigatetheclassificationandcurativestrategyforIatrogenicbileductin— jury． Methods Aretrospectivesurvey0f64patientswithiatrogenicbileductinjuryfromJanuary1982toJuly 2009wasobtainedtoevaluatethecurativeeffect．ResultsOpenoperationaccountedfor70．3％(4546／)ofiatro— genicbileductinjury，and29．7％(19／46)occurredinlaparoscopicoperation．Thirtycaseswerefoundduringopera— tion，34caseswerediagnosedafteroperation．57．8％(37／64)ofiatrogenicinjurycaseswerelocationinuppercom- mortbileduct-hepaticcommonduct，12．5％(846／ )wereinlowercommonbileduckand29．7％(196／4)ofinjury wereinliverbileduct． Conclusions Itisimpoanattocontroltheintrehepaticarterybleedinginiatrogenieintra- hepaticbileductinjury．Iatrogenictraumainhteendpartofcommonbileductcomplicatedwithpancreaserupture needtoberepairedwithpancreaticoduodeno-jejunostomy．Itneedbeemphasizedtorepairtraumaaccordingtoin— dividualfeatureincasesofuppercommonbileduct-hepatic／commonductinjury．Withoutbileleak，bileductinjure occurredafterlaparoscopicoperationmaybesafelyearlyrepaired． K【eywords】Intraoperativecomplications；Surgicalinjuries；Iatrogenicbileductinjury；Treatment 医源性胆道损伤一