White T T, Hart M J
Am J Surg. 1985 May;149(5):640-3. doi: 10.1016/s0002-9610(85)80146-x.
Eighteen instances of bile duct injury over the past 25 years have been reported. Manipulation of a minute cystic duct where the common bile duct was 3 mm in diameter or less was responsible for the division of the duct in eight cases. Most of the commercial catheters are sharp, about 2 mm in diameter, and can easily divide the bile duct if pushed too far. Since manipulation of the duct with a mosquito or tonsil clamp to insert other smaller catheters can also divide a small bile duct, we have decided to discontinue obtaining cholangiograms under these circumstances. Longitudinal splitting of two additional 3 mm ducts with a 3 mm dilator was another major source of injury. Overclipping of the cystic artery to involve the hepatic duct and overmobilization of the bile duct were other sources of injury. We have ceased attempting to obtain cholangiograms in patients with small cystic ducts because of the availability of endoscopic sphincterotomy, the low yield of the films under these circumstances, and fear of damaging the ducts. We use hepaticojejunostomy with Silastic tube stenting for repair of bile duct injuries.
据报道，在过去25年中有18例胆管损伤病例。在8例病例中，胆总管直径为3毫米或更小的情况下对微小胆囊管进行操作导致了胆管的断裂。大多数商用导管很尖锐，直径约为2毫米，如果推进得太深很容易切断胆管。由于用蚊式钳或扁桃体钳操作胆管以插入其他较小的导管也可能切断小胆管，我们决定在这些情况下停止进行胆管造影。用3毫米扩张器纵向劈开另外两条3毫米的胆管是另一个主要的损伤来源。胆囊动脉过度夹闭累及肝管以及胆管过度游离是其他损伤来源。由于有内镜下括约肌切开术，在这些情况下胆管造影照片的阳性率低，并且担心损伤胆管，我们已停止对胆囊管细小的患者进行胆管造影检查。我们采用肝空肠吻合术并放置硅橡胶管支架来修复胆管损伤。
