胆囊切除术致肝外胆管损伤临床诊断和治疗.docVIP

胆囊切除术致肝外胆管损伤临床诊断和治疗 　　【摘要】 目的：探讨如何预防和处理由胆囊切除术所致的肝外胆管损伤。 方法：对本院普外科2008年2月-2013年1月诊治的28例因胆囊切除术导致肝外胆管损伤的患者进行回顾性分析，分析其损伤部位、类型及诊断要点、手术方式和预后。 结果：全部病例经相关处理后均治愈，予胆管修补术及胆总管T管引流术者3个月后拔管，予肝门部胆管空肠Roux-en-y吻合和T管引流术者9个月后拔管，手术后均经8～21 d出院，28例患者5年内随访均无异常。 结论：施行胆囊切除术时要掌握、分辨胆囊三角区复杂的解剖结构，选择适当的手术时机和手术方式，在术中和术后要严密监测手术野、患者自身和切口情况，尽量在术中对胆管损伤做出诊断和处理，采用合理的手术方式进行修补和引流。 　　【关键词】 胆囊切除术； 肝外胆管损伤； 诊断； 治疗 　　Clinical Diagnosis and Treatment of Extrahepatic Bile Duct Injury Resulted from Cholecystectomy/GAO Xian-rui.//Medical Innovation of China，2014，11（01）：142-143 　　【Abstract】 Objective：To investigate how to prevent and solve extrahepatic bile duct injury resulted from cholecystectomy.Method：The injured part，the type，the diagnostic main points，the operation method and the prognosis of 28 patients with extrahepatic bile duct injury resulted from cholecystectomy during Feb 2008 and Jan 2013 were analyzed.Result：After the treatment，all the patients were cured.Some patients who were given surgical repair of bile duct and common bile duct t-tube drainage carry out extubation after three monthes.Some patients who were given the hepatic bile duct jejunum Roux-en-y portal vein anastomosis and common bile duct t-tube drainage carry out extubation after nine monthes.All the patients left hospital between 8 and 21 days after operation.During 5 years after operation，28 patients all were healthy.Conclusion：When have cholecystectomy，it is important that make sure the implex anatomical structure of gallbladder triangle，choose the appropriate time and way of operation，observe the operating field and the clinical situation carefully during and after operation.It had better to make a diagnosis and treat extrahepatic bile duct injury，then choose appropriate way to fix and drainage. 　　【Key words】 Extrahepatic bile duct injury； Cholecystectomy； Diagnosis； Treatment 　　First-author’s address：The People’s Hospital of Juancheng County， Juancheng 274600，China 　　doi：10.3969/j.issn.1674-4985.2014.01.067 　　胆囊切除术是临床常见腹部手