再论医源性胆道损伤.docVIP

精品论文 参考文献 再论医源性胆道损伤 蔡瑞福1 顾冕1 徐友标2 李国安2 (1淮南市新康医院普外科二病区 安徽淮南 232007) (2安徽理工大学医学院附属东方医院普外科 安徽淮南 232001) 【中图分类号】R61【文献标识码】A【文章编号】1672-5085(2013)29-0024-02 【摘要】 目的 探讨医源性胆道损伤的原因及处理原则。方法 回顾性总结我院和安徽理工大学附属东方总院，收治32例医源性胆道损伤的临床资料：13例开腹胆囊切除术(OC)，19例腹腔镜胆囊切除术(LC)。32例中：18例胆总管断裂伤等，即行对端吻合或胆肠吻合；6例伤及高位胆管，改行“改良式肝门空肠吻合术”。另8例术后确诊(4例外院转至)，择期适时行确定性手术。结果 随访由2006年1月年至2012年12月，最短2年余，2例偶有胆道逆行感染，4例胆管再狭窄，2例并发其他感染衰竭死亡，其余疗效尚满意。结论 医源性胆道损伤是以复杂而棘手的难题，一旦发生应即时处理，如术后明确诊断，应依据损伤类型，采取不同处理方法，做到早期发现，正确处理，总体疗效尚好。 【关键词】 医源性胆道损伤 改良式肝门空肠吻合术 Improvement management of iatrogenic biliary tract injury. Cai Ruifu, Gu Mian ,Xu Youbiao, Li Guoan Department of General Surgery, Xinkang Hospital, Huainan,232007,China 【Abstract】 Objictive To investigate the reasons and managemental principle of the iatrogenic biliary tract injury. Methods The patientrsquo;s clinical data were collected from our hospital and Affiliated hospital of Anhui University of Science ＆ Technology . In all 32 cases patients, 13 patients were to perform an open cholecystectomy (OC) and 19 patients were to perform a early laparoscopic cholecystectomy (LC). 18 cases patients with choledoch trauma of breakage were underwent end-to-end anastomosis. 6 cases patients with high-level biliary tract injury were underwent modified porto-jejunal anastomosis. The six others patients were definitely diagnosed after operation and they choosen data for deterministic surgery. Results The results showed that for follow-up a period five years from January 2006 to December 2012 (makes a follow-up short for 1 year ), 2 case patient had a biliary tract retrograde infection occasionally. 4 cases patients have re-stenosis of the bile duct. 2 case patient was died because of accompanying other infection. Remaining patients have a satisfactory result of treatment. Conclusions Iatrogenic biliary tract injury was a complicated and intractability medical difficult problem. When their occurred should be immediate treatment. If the definitely diagnosed were posto