CAJ | 학술논문

目的：探讨医源性胆管损伤原因及诊治经验．方法回顾性分析1995年1月至2011年9月云南省第三人民医院收治的28例胆囊切除术致胆管损伤患者的临床资料．结果全部病例均在术中发现并诊断．8例损伤较轻行腹腔引流；6例修补胆管裂口加T管引流；首次手术行胆肠Roux-y吻合术4例；行胆汁外引流后再次修复行胆肠Roux-y吻合术1例；首次手术行胆管端-端吻合术9例，其中7例并发吻合口狭窄经二次及二次以上修复手术，1例使用脐静脉瓣修复，另6例行胆肠Roux-y吻合术修复．全组死亡2例，26例痊愈，随访2 a以上．结论医源性胆管损伤首次手术至关重要．胆肠Roux-y吻合术是修复手术的首选术式，应由有经验的专科医生实施手术.
목적：탐토의원성담관손상원인급진치경험．방법회고성분석1995년1월지2011년9월운남성제삼인민의원수치적28례담낭절제술치담관손상환자적림상자료．결과전부병례균재술중발현병진단．8례손상교경행복강인류；6례수보담관렬구가T관인류；수차수술행담장Roux-y문합술4례；행담즙외인류후재차수복행담장Roux-y문합술1례；수차수술행담관단-단문합술9례，기중7례병발문합구협착경이차급이차이상수복수술，1례사용제정맥판수복，령6례행담장Roux-y문합술수복．전조사망2례，26례전유，수방2 a이상．결론의원성담관손상수차수술지관중요．담장Roux-y문합술시수복수술적수선술식，응유유경험적전과의생실시수술.
Objective To explore the causes and the consequences of iatrogenic bile duct injury as well as experiences in its diagnosis and treatment. Method The clinical data of 28 in-patients who suffered from bile duct injury followed by cholecystectomy during January 1995 to September 2011 were collected and retrospectively analyzed. Result Bile duct injuries were found and diagnosed in al 28 in-patients during the processes of reoperation. Different treatments were carried out. 8 cases with mild injury were treated by placing the abdominal cavity drainage. 6 cases with bile duct split were repaired and set up with T tube drainage. 4 cases were initially treated by bile-intestinal Roux-y anastomosis. 1 case received repair operation of bile-intestinal Roux-y anastomosis after the external drainage of bile. 9 cases were initially treated with end-end bile duct anastomosis and 7 of 9 cases with concurrent anastomotic stenosis were performed repairing re-operations twice or more than twice. Among 7 cases, 1 case was performed with the operation of umbilical vein flap repair while 6 cases were treated with bile-intestinal Roux-y anastomosis repair. All cases in this observation were followed up to two years after repairing surgery:2 patients died and the rest 26 patients recovered after treatment. Conclusions The initial repairing operation is critical for iatrogenic bile duct injury and bile-intestinal Roux-y anastomosis should be the first choice of therapy,and it should be operated by experienced surgeons.