| 胆囊切除致医源性肝外胆道损伤的外科诊治 |
| 投稿时间：2011-09-15 修订日期：2011-10-28 点此下载全文 |
| 引用本文：沈伟敏,陆贝,封光华.胆囊切除致医源性肝外胆道损伤的外科诊治[J].医学研究杂志,2012,41(1):128-130 |
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| 中文摘要:目的探讨胆囊切除术导致肝外胆道损伤的原因及外科处理方法。方法回顾性分析笔者医院2000年1月~2010年12月期间，21例行胆囊切除术导致医源性胆道损伤的临床资料。 结果21例病例中胆总管损伤12例，肝总管损伤2例，右肝管及左右肝管汇合部损伤各1例，迷走胆管损伤5例；术中发现15例，术后发现6例。18例随访6个月~8年，其中优13例，良4例，差1例。结论胆囊手术时理清解剖关系、规范操作、避免盲目操作，并适时中转开腹手术，可降低医源性胆道损伤的发生率。术中发现胆管损伤，应 Ⅰ 期修补或重建，Ⅱ 期修复则宜行规范的胆肠吻合术。尽早发现、及时处理能有效防止术后胆管狭窄。 |
| 中文关键词:胆囊切除术 胆道 损伤 |
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| Surgical Approach for Iatrogenic Extrahepat Bile Duct Injury by Cholecystectomy |
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| Abstract:ObjectiveTo discuss the diagnosis and treatment of bile duct injury in cholecystectomy. MethodsTotally 21 cases of iatrogenic extrahepat bile duct injury in cholecystectomy were retrospectively analyzed from January 2000 to December 2010. ResultsCommon bile duct injury was seen in 12 cases, hepatic duct injury in 2 cases, right hepatic duct injury in 1 case, hepatic duct confluence department injury in 1 case, aberrant duct injury in 5 cases. 15 cases were identified during the operation and 6 cases after operation. Follow-up data of 18 cases with 6 months to 8 years showed 13 cases excellent, 4 cases good，1 case bad after reoperation. ConclusionClarifing the anatomic relationship, standard operation, conversing to laparotomy timely could reduce the incidence of bile duct injury. Repair or biliary intestinal anastomosis should be performed if the injury is found intraoperatively. Standard choledochojejunostomy is suitable to the cases identified postoperatively．Early diagnosis，eraly treatment are essential to prevent stricture after operation. |
| keywords:Cholecystectomy Bileduct Injury |
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