医源性胆道损伤22例体会

doi:10.3969/j.issn.1005-6483.2020.04.017

摘要/Abstract

摘要： 目的总结医源性胆道损伤进行个体化、多模式处理的方法及可行性。方法 2010年1月～2018年12月我院普外科经治的医源性胆管损伤22例，根据发生胆道损伤后临床表现及损伤类型，分别采取通畅外引流或联合内镜下胆道内引流、胆道整形修补、胆肠吻合等措施进行处理和损伤控制性手术。结果进行定位穿刺引流、保留引流管通畅外引流或联合内镜内引流共5例，手术进行损伤胆道修补或联合T管支撑引流9例，行Roux-en-Y胆肠吻合8例，其中进行损伤控制性手术1例。总体治疗有效率100%。结论医源性胆道损伤类型多，可伴随出现各种严重并发症，临床表现各异，应根据不同临床表现及不同损伤类型，采取个体化、多模式的治疗措施。

关键词: 医源性胆道损伤, 腹腔镜胆囊切除术, 胆囊切除术, 内镜逆行性胰胆管造影, 胆肠吻合术

Abstract: Objective To explore the method and feasibility of individualized and multi-mode management for iatrogenic bile duct injury（IBDI）. Methods From January 2010 to December 2018，22 cases of iatrogenic bile duct injury in general surgery of Panzhihua Group General Hospital of Panzhihua City were retrospectively reviewed.According to the clinical manifestation and injury type of biliary tract injury，the patients were treated with unobstructed external drainage or combined endoscopic biliary duct drainage，biliary plastic repair，choledochojejunostomy，and injury control surgery. Results There were 22 cases of iatrogenic bile duct injury，5 cases were treated with location puncture drainage or external drainage or combined endoscopic drainage，and 9 cases underwent repair of bile duct injury or combined T-tube support drainage.Roux-en-Y choledochojejunostomy was performed in 8 cases，including injury control surgery in 1 case.Overall effective rate 100%. Conclusion Iatrogenic bile duct injury has many types，clinical manifestations are different，or even accompanied by various serious complications.Individualized and multi-mode treatment measures should be taken according to different clinical manifestations and different injury types.

Key words: Iatrogenic bile duct injury, laparoscopic cholecystectomy, cholecystectomy, endoscopic retrograde cholangiopancreatography, cholangiojejunostomy

刘召洪王家兴林龙英李捷杨志. 医源性胆道损伤22例体会[J]. 临床外科杂志, 2020, 28(4): 353-356.

LIU Zhaohong, WANG Jiaxing, LIN Longying, et al.. Experience of 22 cases of iatrogenic bile duct injury[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(4): 353-356.

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