胆囊切除致胆管损伤的诊治

摘要

Objective To investigate the reasons and preventive measures and treatments of bile ducts injury in cholecystectomy. Methods Clinical data of 27 cases of bile ducts injury caused by cholecystectomy during 7 years were retrospectively analyzed. These 27 cases received a total of 34 sessions procedures, choledochojejunal Roux-en-Y anastomosis in 19 sessions procedures, abdominal cavity drainage in 2 sessions procedures, bile duct neoplasty in 2 sessions procedures, end-to-end anastomosis of bile duct with T-tube pedestal drainage in 3 sessions procedures, bile duct neoplasty with T tube pedestal drainage in 3 sessions procedures, ENBD in 1 case, bile duct reconstruction with pedicled umbilical vain graft in 1 case. Results In short-term,20 cases( 74. 1% )achieved good effect,fair in 6 cases ( 22.2% ),died in 1 case( 3. 7% ). In 20 cases undergoing average 3-year follow-up, achieved good 15 cases( 75. 0% ),fair 4 cases (20.0% )and bad 1 case( 5.0% ). In non-death cases of illness, choledochojejunal Roux-en-Y anastomosis 15 cases, good 11 cases ( 73. 3% ) ,fair 3 cases( 20. 0% ) ,bad 1 case( 6. 7% ). Conclusions Iatrogenic dile duct injury is prone to occur during cholecystectomy. The main reason of bile duct damage is unsuitable modus operandi for three basic factors including pathology, anatomy and human factor. Bile duct damages will obtain good treatment results, the key to is which prompt discovery and correct and timely treatment. Choledochojejunal Roux-en-Y anastomosis technique is an effective method for most of the injury of bile duct and biliary stricture cases.%目的 探讨胆囊切除致胆管损伤的原因及防治措施.方法 回顾性分析近7年收治27例胆囊切除致胆管损伤的临床资料.27例胆囊切除致胆管损伤中,实施手术34例次.胆肠Roux-en-Y吻合术19例次,腹腔引流术2例次,胆管修补术2例次,胆管对端吻合、T管支撑引流术3例次,胆管修补、T管支撑引流术3例次,内镜下鼻胆管引流(endoscopic nasobiliary drainage,ENBD)和肝总管自体脐静脉瓣修复各1例等.结果 全组末次近期效果:优20例(74.1%),良6例(22.2%),死亡1例(3.7%).随访2~7年(平均3年)20例,优15例(75.0%),良4例(20.0%),差1例(5.0%),无死亡病例,其中胆肠Roux-en-Y吻合术15例,优11例(73.3%),良3例(20.0%),差1例(6.7%).结论 胆囊切除术容易发生胆管损伤,损伤的原因是在病理、解剖和人为因素的基础上,主要与其术式选择不当有关.胆管损伤时要取得好的治疗效果,关键是及时发现和正确处理.胆管空肠Roux-en-Y吻合术是大多数胆管损伤或损伤性胆管狭窄修复重建的有效术式.