【摘要】 目的 :总结医源性胆道损伤的经验教训。方法 :对过去 2 0年间医源性胆道损伤的 2 1例病人进行回顾性分析。结果 :单纯胆囊切除致伤 13例 (6 1 9% ) ,胆总管探查致伤 5例 (2 3 8% ) ,胃大部切除术致伤 2例(9 5 % ) ,胆管囊肿手术损伤 1例 (4 8% ) ;损伤部位在胆总管 10例 (4 7 6 % ) ,肝总管 5例 (2 3 8% ) ,肝门部胆管损伤 3例 (14 3% ) ,其它部位 3例 (14 3% )。除 2例死亡 ,4例失访外 ,其余 15例随访时间均超过 2年 ,随访率78 9% ,疗效优良率为 86 7%。结论 :所有病例最终均需手术处理。手术方式根据损伤部位、类型、损伤后发现的时间具体决定 ,以胆管 空肠Roux en Y吻合术的疗效最佳。除解剖变异、病理变化外 ,手术者的责任心与技术因素是引起医源性胆管损伤的主要原因更多还原

【Abstract】 objective:To summarize the experience and instruction in iatrogenic biliary duct injury.Methods:21 patients with iatrogenic biliary duct injuries occurred in the past 20 years were studied retrospectively.Results:13 cases were injured in cholecystectomy(61.9%),5 cases in exploration of common bile duct(23.8),2 cases in partial gastrectomy(9.5%),and 1 case in choledochocelectony(4.8%).The locations of injuries were at common bile duct(10 cases,47.6%),at common hepatic duct(5 cases,23.8%),at bile duct of hepatic portal(3 cases,14.3%),and at others(3 case,14.3%).Besides 2 patients died and 4 patients dismissed follow up,the rest patients were followed for more than 2 years(78.9%).86.7% treatment was satisfactory.Conclusion:All patients were treated ultimately by operation.The method of treatment was dicided according to the type of injury and the time after injury.The most effective operational style was the Roux en Y cholangiojejunostomy.The main cause of iatrogenic biliary duct injury was of the operator lack;of responsibility and experience or skill during operation besides the anatomy variety or pathological change.Some preventive measure against iatrogenic biliary duct injuries were discussed.[WT5”HZ]更多还原