【摘要】 目的探讨医源性胆道损伤处理原则的演变及其效果的对比。方法回顾性分析和总结1996~2001年和2004~2009年间我院收治的50例医源性胆道损伤的临床资料和随访结果。结果前阶段处理28例,其中术中即时修复11例,术后17例,术中修复以胆管端端吻合为主,后期修复以胆管-空肠Roux-Y吻和为主,后阶段处理22例,术中发现修复4例,术后18例,术中修复以胆管修复+T管引流为主,后期修复以胆管-空肠Roux-Y吻合术为主,延期手术预先进行胆管+腹腔引流,2月后再行胆管空肠Roux-Y吻合术,一期手术修复成功率分别为52%(13/25)和90.9%(20/22)(P<0.05)。结论手术方式及手术者是提高修复率的主要因素,手术时机选择次之,术中发现以胆管修复术为主,后期以胆管-空肠Roux-Y吻合为主要术式,一期重建手术环境不成熟时要果断延期手术。更多还原

【Abstract】 Objective To explore the development of managment for iatrogenic injury of bile duct and contrast their effect. Methods The clinical data of 50 patients with iatrogenic injury of bile duct referred to our hospital from 1996 to 2001 and from 2004 to 2009 were analyzed and summarized retrospectively. Results There were 28 patiends in the first phase,11 cases were found and repaired during the operation, 17 cases repaired after injury,end-to-end anastomosis of bile duct and bile duct-to-intestines anastomosis were main modus operated in the operation of injury, Late repair mainly performed Roux-en-Y bile duct-jejunostomy,In the second phase there were 22 patiends, 4 cases were found and repaired during the operation, 18 cases done after injury, biliary repair were main modus operate in the operation of injury, Late repair mainly performed Roux-en-Y bile duct-jejunostomy, 5 cases were performed drainage of bile duct and abdomen at first,late done Roux-en-Y bile duct-jejunostomy, experienced operators performed 18 cases. following up these patients, rate of successful reconstruction of bile duct in the initial repair was 52%(13/25) and 90.9%(20/22).Conclusion The surgical technical level and modus operate of repair were the main factors. The second was the choice of repair time, biliary repair were main modus operandi in the operation of injury, Late repair mainly performed Roux-en-Y bile duct-jejunostomy ,if no good circumstance of operation,we should handling by stages.更多还原