摘要
目的 探讨胆管损伤的早期处理方法及治疗效果。方法 总结第四军医大学西京医院和解放军四五一医院2000年1月至2007年7月24972例胆囊切除中110例胆管损伤患者的治疗方法。早期处理包括：保守治疗、一期修补、胆管对端吻合、胆肠Roux-en-Y吻合、带蒂组织瓣修补、二次开腹引流、ERCP＋ENBD。经过上述方法处理后未再手术者视为早期处理效果良好，再次接受手术治疗或内镜下置入支架治疗者视为早期处理效果不佳。结果 110例胆管损伤早期处理后效果良好的比例，胆管壁单纯裂口伤为100％（19／19）；Bismuth Ⅰ型为57％（20／35），Ⅱ型为50％（21／42），Ⅲ型为38％（3／8），Ⅳ型为0（0／6）。开放法胆囊切除术造成的胆管损伤，修复后远期疗效优于LC。结论 胆管损伤越重，再次手术率越高。胆管损伤的处理要根据损伤类型、局部和全身情况，选择最佳方法，以获得良好的远期效果。
Objective To investigate early management of bile duct injury and evaluate the long-term outcome. Methods The management experience of 110 bile duct injuries out of 24 972 patients who underwent cholecystectomy from January 2000 to July 2007 in Xijing Hospital and No. 451 Hospital of PLA was reviewed retrospectively. Ways of early management included conservative treatment, primary repair, duct-to-duct anastomosis, Roux-en-Y cholangiojejunostomy, bile duct repair with pedicle tissue flaps, secondary drainage, and ERCP ＋ nasobiliary drainage. Good result was defined that the patients did not undergo any surgical procedure after the early management, while poor result was defined that the patients who received operation or stent under endoscope after the early management. Results For patients with simple tear of bile duct, bile duct stricture of Bismuth Grade Ⅰ, Grade Ⅰ, Grade Ⅲ and Grade Ⅳ, the ratio of good long-term outcome after early management was 100% （ 19/19）, 57% （20/35） , 50% （21/42） , 38% （3/8） and 0（0/6） , respectively. The long-term outcome of bile duct injury caused by open cholecystectomy was better than that caused by laparoscopic cholecystectomy. Conclusions Choice of early management for bile duct injury depends on the type of injury and the condition of the patient.
出处
《中华消化外科杂志》
CAS
CSCD
2008年第1期19-21,共3页
Chinese Journal of Digestive Surgery
关键词
胆管损伤
早期处理
Bile duct injury
Early management
