医原性疾病_____医原性疾病;_胆管_损伤;

医源性胆管损伤修复后再手术原因分析及防治

http://www.100md.com 《第四军医大学学报》 2003年第8期

医原性疾病,,医原性疾病;,胆管,损伤;,再手术,0引言,1临床资料,2结果,3讨论,【参考文献】

     (第四军医大学西京医院肝胆外科，陕西西安 710033)

    Discussion on the causes and treatment of iatrogenic bile duct damage after first reparative operation

    LI HaiMing, DOU KeFeng, SUN Kai, GAO ZhiQing, LI KaiZong, FU YouChi

    Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xian 710033, China

    【 Abstract 】 AIM: To discuss the causes and prevention of re-operation of iatrogenic bile duct after first reparative operation. METHODS: 129 cases of iatrogenic bile duct damage within the past 20 years were reviewed and analyzed. Of the 129 cases, 120 cases underwent two operations and 108 cases underwent three operations. RESULTS: The third operation rate (90%, 108/120) was related with the causes of damage, damage sites, types of the first operation and second reparation time, but was not related with sex and age. Damage rates of laparoscopy, open abdominal operation and cholecystectomy with exploration of common bile duct were 100%, 9130% and 7143% respectively. Damage rates of common hepatic duct, porta hepatic duct, high bile duct and common bile duct were 9452%, 9167%, 9231% and 5556% respectively. CONCLUSION: Iatrogenic damage of bile duct should be diagnozed and repaired within 48 hours. Bile duct repair operation is not suggested within 4 weeks. Roux-y cholangio-jejunostomy is the best management for iatrogenic damage of bile duct after 4 weeks. Inter-bile drainage should also be kept for at least half a year to reduce the rate of cholangitis and to promote the efficacy of the operation. ......

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