摘要
胆管损伤是肝切除术过程中重大的并发症。其临床表现与胆囊切除术造成的损伤不同。其主要的临床表现有胆漏、梗阻性黄疸及胆道出血等。胆管损伤的发生与手术方式关系密切,涉及到4段肝切除时胆管损伤发生率明显增加。当病灶位于4段时,术前准备应当更加充分,对影像学资料的解读更全面。术前的超声检查比较方便易行,对术中肝脏切面的选择有较大的帮助。肝切除术后胆管损伤以胆漏最为常见,胆漏发生后,应当充分引流,防止胆汁积聚在腹腔进而造成感染。当证实或怀疑有胆漏发生时,可进行各种形式的胆道减压。如果胆汁不能引流至胃肠道或有机械性梗阻时,往往需要外科处理。
Biliary injury is a major complication in the process of hepatectomy. The clinical manifestation of biliary injury is quite different from that from cholecystectomy. The main presentations of biliary injury after hepatectomy are bile leakage, obstructive jaundice and biliary bleeding. The biliary injury is strongly associated with the type of the hepatectomy procedure, especially when the resection of the liver is associated with the segment 4. When the lesion is located in segment 4, careful preoperative preparations is a must, asking for the careful interpretation of the imaging data. Preoperative ultrasonography is recommended for its convenience of usage and will be helpful for the selection of the cutting surface of the hepatic lesion. Bile leakage is the most commonly seen after hepateetomy, and the drainage is the first choice for patients in case of bile collection in the abdominal cavity or even abscess formation. Biliary decompression is recommended when the bile leakage is suspected or documented. Surgery is indicated for some patients when the bile drainage is cut from the intestinal passage or the mechanic obstruction is overt.
出处
《中国实用外科杂志》
CSCD
北大核心
2011年第7期575-578,共4页
Chinese Journal of Practical Surgery
关键词
胆管损伤
肝切除
bile duct injury
hepatectomy
