医源性胆管损伤修复后再手术原因分析及防治(医学论文).pdfVIP

医源性胆管损伤修复后再手术原因分析及防治 作者：李海民 ，窦科峰，孙凯，高志清，李开宗，付由池 【关键词】 医原性疾病 【 Abstract 】 AIM: To discuss the causes and prevention of re-operation of iatrogenic bile duct after first reparative operation. METHODS: 129 cases of iatrogenic bile duct damage within the past 20 years were reviewed and analyzed. Of the 129 cases, 120 cases underwent two operations and 108 cases underwent three operations. RESULTS: The third operation rate (90%, 108/120) was related with the causes of damage, damage sites, types of the first operation and second reparation time, but was not related with sex and age. Damage rates of laparoscopy, open abdominal operation and cholecystectomy with exploration of common bile duct were 100%, 9130% and 7143% respectively. Damage rates of common hepatic duct, porta hepatic duct, high bile duct and common bile duct were 9452%, 9167%, 9231% and 5556% respectively. CONCLUSION: Iatrogenic damage of bile duct should be diagnozed and repaired within 48 hours. Bile duct repair operation is not suggested within 4 weeks. Roux-y 更多精品文档 ,欢迎来我主页查询 cholangio-jejunostomy is the best management for iatrogenic damage of bile duct after 4 weeks. Inter-bile drainage should also be kept for at least half a year to reduce the rate of cholangitis and to promote the efficacy of the operation. 【Keywords 】 Iatrogenic disease;bile ducts/injuries; reoperation 【摘 要】目的 : 探讨医源性胆管损伤修复后再手术的原因及防 治 .方法 : 对 20 a 中 129 例医源性胆管损伤， 120 例修复后 108 例 再手术患者，损伤部位和修复时机进行回顾性分析 .结果 : 再手术率 90% （108/120 ）；再手术率与患者性别、年龄无显著关系；再手术 率与损伤原因、损伤部位、 修复时机、手术方式和手术操作等因素有 关； 腹腔镜胆囊切除术 （LC ）胆管损伤修复后再手术率最高 （100% ）， 开腹胆囊切除术（ OC ）次之（ 9130% ）、 OC+ 胆管探查术最低