摘要
目的总结胆道手术中防治副肝管损伤的经验。方法回顾分析近1 0年间发现的2 6例副肝管病例资料。结果2 6例病例中I型1 0例,占3 8.5%,均被切断、结扎,术后无胆汁漏、胆系感染或梗黄发生;II型7例,占2 6.9%,损伤3例,经相应处理,未发生并发症;III型6例,占23.1%,损伤2例,1例术后发生胆漏,经再次手术治愈。IV型2例,占7.7%,2例均得以保护,未损伤。V型1例,占3.8%,术前得以确诊,未损伤。结论为防止副肝管损伤,应加强术前、术中副肝管诊断,尤其是术中胆道造影。不同类型副肝管损伤,处理上应分别对待。对于I型胆囊胆管可切断结扎,II型汇入胆囊管的副肝管应尽量保护,如损伤,根据管径大小,采取不同处理方法。III型、IV型副肝管均应保护,防止损伤,如损伤,采用修补或内引流术,防止术后发生严重并发症。
Objective To summarize our experience in the prevention and treatment of accessory hepatic duct injury during operation on biliary tract. Methods The clinical data of 26 cases with accessory hepatic duct were retrospectively reviewed. Results Of 26 cases, the accessory hepatic duct were type Ⅰ in 38. 5% （ 10/26 ） , and no complications including bile leakage, biliary infection and obstructive jaundice developed after division and ligation of the accessory hepatic duct; 26.9% （7/26） were type II, among which, the accessory hepatic duct were injured in 3 cases, but no case developecl complications after relevant treatment ; 23.0% （ 6/26 ） were type Ⅲ, among which, injury of accessory bile duct occurred in 2 cases. Of them, 1 case developed bile leakage and was cured by re-operation. 7. 7% （2/26） were type Ⅳ and 3. 9% （ 1/26 ） was type Ⅴ. The cases of type Ⅳ and Ⅴ were not damaged. Conclusions To prevent injury of accessory hepatic duct, pre-and intra-operation identification of the condition is very important, and especially by intraoperative eholangiagraphy. Different types of accessory hepatic duct injury should be treated by different approaches. Accessory hepatic duct of type Ⅰ might be cut and ligated. Type Ⅱ accessory bile duct which enters the cystic duct and should be protected, but, if damaged, different methods of treatment are used, depending on the caliber of accessory hepatic duct. Type Ⅲ and Ⅳ also should be protected, but, when damaged, the accessory hepatic duct should be repaired or performed an internal draining.
出处
《中国普通外科杂志》
CAS
CSCD
2006年第3期214-217,共4页
China Journal of General Surgery
