医源性胆管损伤患者的临床分析

Clinical analysis of patients with iatrogenic bile duct injury.

作者信息

Yang Wei-Liang, Zhang Dong-Wei, Zhang Xin-Chen

机构信息

Department of General Surgery, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2006 May;5(2):283-5.

PMID:16698592

Abstract

BACKGROUND

The main cause of iatrogenic bile duct injury is misidentification of the common bile duct as the cystic duct. In this article, we summarize the experience in the treatment of 112 patients with iatrogenic bile duct injury.

METHOD

Clinical data of these patients treated at 10 hospitals of Songhua river area, Heilongjiang province, China from January 1978 to January 2005 were analyzed retrospectively.

RESULTS

In 55.4% patients (62/112), iatrogenic bile duct injury was due to misidentification of the anatomy of Calot's triangle before cholecystectomy. Their diagnosis was based on clinical features, celiac puncture and imaging examination in which ultrasonography was most sensitive, giving a diagnostic rate of 97.5%. Six types of injury were identified according to their locations, and type III damage was commonly seen (92/112). The curative rate in this group was 95.5% (107/112). Eighty-seven patients (77.7%) underwent Roux-en-Y choledochojejunostomy with a cure rate of 94.3% (82/87).

CONCLUSION

The prevention of iatrogenic bile duct injury lies in identifying the topography of extrahepatic bile ducts. Roux-en-Y choledochojejunostomy is usually the treatment of choice.

摘要

背景

医源性胆管损伤的主要原因是将胆总管误认作胆囊管。在本文中，我们总结了112例医源性胆管损伤患者的治疗经验。

方法

回顾性分析1978年1月至2005年1月在中国黑龙江省松花江地区10家医院治疗的这些患者的临床资料。

结果

在55.4%的患者（62/112）中，医源性胆管损伤是由于胆囊切除术前对胆囊三角解剖结构的误认。其诊断基于临床特征、腹腔穿刺和影像学检查，其中超声检查最为敏感，诊断率为97.5%。根据损伤部位确定了六种损伤类型，Ⅲ型损伤最为常见（92/112）。该组治愈率为95.5%（107/112）。87例患者（77.7%）接受了Roux-en-Y胆总管空肠吻合术，治愈率为94.3%（82/87）。