CAJ | 학술논문

目的：探讨医源性胆道损伤的原因及处理原则。方法回顾性总结我院和安徽理工大学附属东方总院，收治32例医源性胆道损伤的临床资料：13例开腹胆囊切除术(O C)，19例腹腔镜胆囊切除术(L C)。32例中：18例胆总管断裂伤等，即行对端吻合或胆肠吻合；6例伤及高位胆管，改行“改良式肝门空肠吻合术”。另8例术后确诊(4例外院转至)，择期适时行确定性手术。结果随访由2006年1月年至2012年12月，最短2年余，2例偶有胆道逆行感染，4例胆管再狭窄，2例并发其他感染衰竭死亡，其余疗效尚满意。结论医源性胆道损伤是以复杂而棘手的难题，一旦发生应即时处理，如术后明确诊断，应依据损伤类型，采取不同处理方法，做到早期发现，正确处理，总体疗效尚好。
목적：탐토의원성담도손상적원인급처리원칙。방법회고성총결아원화안휘리공대학부속동방총원，수치32례의원성담도손상적림상자료：13례개복담낭절제술(O C)，19례복강경담낭절제술(L C)。32례중：18례담총관단렬상등，즉행대단문합혹담장문합；6례상급고위담관，개행“개량식간문공장문합술”。령8례술후학진(4예외원전지)，택기괄시행학정성수술。결과수방유2006년1월년지2012년12월，최단2년여，2례우유담도역행감염，4례담관재협착，2례병발기타감염쇠갈사망，기여료효상만의。결론의원성담도손상시이복잡이극수적난제，일단발생응즉시처리，여술후명학진단，응의거손상류형，채취불동처리방법，주도조기발현，정학처리，총체료효상호。
Objictive To investigate the reasons and managemental principle of the iatrogenic biliary tract injury. Methods The patient’s clinical data were collected from our hospital and Affiliated hospital of Anhui University of Science & Technology . In all 32 cases patients, 13 patients were to perform an open cholecystectomy (OC) and 19 patients were to perform a early laparoscopic cholecystectomy (LC). 18 cases patients with choledoch trauma of breakage were underwent end-to-end anastomosis. 6 cases patients with high-level biliary tract injury were underwent modified porto-jejunal anastomosis. The six others patients were definitely diagnosed after operation and they choosen data for deterministic surgery. Results The results showed that for follow-up a period five years from January 2006 to December 2012 (makes a follow-up short for 1 year ), 2 case patient had a biliary tract retrograde infection occasionally. 4 cases patients have re-stenosis of the bile duct. 2 case patient was died because of accompanying other infection. Remaining patients have a satisfactory result of treatment. Conclusions Iatrogenic biliary tract injury was a complicated and intractability medical difficult problem. When their occurred should be immediate treatment. If the definitely diagnosed were postoperative, should taken different measures according to different damage types. For the patients with iatrogenic biliary tract injury overall curative effect were fairly good if could be early discovery and appropriately handling it.