医源性胆管损伤的临床诊治进展_寇桂香.docVIP

中国普外基础与临床杂志 2014 年 10 月第 21 卷第 10 期 Chin J Bases Clin General Surg, Vol. 21, No. 10, Oct. 2014 ? 1321 ? 综述 医源性胆管损伤的临床诊治进展 寇桂香1，柴琛2 【摘要】目的 探讨医源性胆管损伤（iatrogenic bile duct injury，IBDI）发生的原因、临床诊治及预防策略。方法 通过文献检索，总结分析 IBDI 的临床诊治措施。结果 IBDI 常见的相关危险因素包括人为因素、局部解剖变异因素和病理因素。依据损伤诊断时间和局部的病理状态，可以选择胆管一期缝合修补术、胆管端端吻合术、胆管-空肠 Roux-en-Y 吻合术等方式手术修复，或行肝切除术、肝移植等。 若并发胆管远端的单纯狭窄也可在 ERCP 下行胆道内支架置入或乳头球囊扩张术（EPBD）。结论 IBDI 重在预防，手术者应注重上腹部手术实施前对 IBDI 的正确认识；一旦发生，应根据具体的损伤类型及时间来选择合理的手术方式予以修复，能够明显提高治疗效果和患者的生存质量。 【关键词】 医源性胆管损伤；诊断；治疗；预防；文献综述 【中图分类号】R657.4 【文献标志码】A Advances in Clinical Diagnosis and Treatment of Iatrogenic Bile Duct Injury KOU Gui-xiang1, ChAI Chen2. 1. Clinical Teaching and Research Section, Health Vocational College of Gansu Province, Lanzhou 730000, Gansu Province, China；2. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou , 730000, Gansu Province, China Corresponding Author：CHAI Chen, E-mail：chasechai@126.com 【Abstract】 Objective To explore the cause, clinical diagnosis and treatment, and prevention strategies of iatrogenic bile duct injury (IBDI). Methods By means of literature retrieval, the clinical diagnosis and treatment measures of patients with IBDI were summarized. Results The related risk factors of IBDI include man-made factors, the local anatomy variation factors, and pathological factors. According to the damage diagnosis time and local pathological state, the repair operations such as bile duct suture repair, biliary tract end to end anastomosis, bile duct jejunum Roux-en-Y anastomosis, bile duct jejunum Roux-en-Y anastomosis, and jejunal artificial valve forming, or liver resection, and liver transplantation were performed. Moreover, it was also available that biliary stent or papillary balloon dilation through ERCP for the bile duct distal stricture. Conclusions It is important that prevention of IBDI. Operation should pay attention to upper abdominal operation prior to the implementation of the correct understandi