目的 探讨医源性胆道损伤的原因和处理原则.方法 回顾性分析和总结近8年来该科收治的27例医源性胆道损伤的临床资料.结果 损伤的27例中有16例是开腹胆囊切除术,11例为腹腔镜胆囊切除术(LC),其中23例发生在二级以下医院,术中发现并行胆管修补的2例,术后发现的25例中,梗阻型有18例,胆漏型2例,梗阻胆漏型5例,术后一个半月内发现再手术处理的16例,胆道损伤处理后胆道狭窄的9例,23例行胆肠内引流,其他行胆管引流术,全部患者获得随访,总体效果优良率达93%(25/27).结论 医源性胆道损伤主要集中在基层医院,胆囊切除术是造成损伤的主要手术,技术水平是重要因素,损伤后的处理需根据类型不同区别对待,良好的胆肠内引流是处理胆道损伤的主要术式.%Aim To analyze the causes and principle of treatment for iatrogenic injury of bile duct. Methods The clinical data of 27 pa tients with iatrogenic injury of bile duct referred to our hospital from 2000 to 2008 were analyzed and summarized retrospectively. Results In all patients. 16 cases performed Open cholecystectomy( OC ), others undergone laparoscopic cholecystectomy( LC ). 23 cases of these were treated in the secondary hospital. 2 cases were be found and be repaired during the first operation. Others were classificated by clini cal symptom. 18 were the type of obstruction,2 were type of biliary fistula. and 5 were type of obstruction and biliary fistula. 16 cases un dergone surgical management between one and half months. Others have restenosis after repairing bile duct. Roux-en-Y bile duct-jejunos tomy were used in 23 cases. All cases were followed up. 25 cases were acquired good curative-effect which occupied 93％( 25/27 ). Conclusion iatrogenic injury of bile duct were mainly occured in the primary hospital. Cholecystectomy was the main operation which result in this injury. The surgical technical level was a important factor. The management for injury should been discriminated according to its type. The favorable Roux-en-Y bile duct-jejunostomy was the main surgical manner for bile duct injury.
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