Experience of Diagnosis and Treatment for Iatrogenic Bile Duct Injury During Cholecystectomy in 17 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李曉延 ,  劉其雨 , 陳剛 , 王帆 , 李立

Corresponding?author：

劉其雨, Email: liuqiyu_12@hotmail.com

Keywords：

醫源性膽管損傷; 膽囊切除術; 診斷; 治療

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目的總結膽囊切除術致醫源性膽管損傷的原因、診斷、治療及預防的經驗。方法回顧性分析昆明市第一人民醫院2006年5月至2011年5月期間經治的17例膽囊切除術致醫源性膽管損傷患者的臨床資料。結果損傷部位包括隆突2例，肝總管3例，膽囊管匯入膽總管部7例，膽總管4例，副肝管1例。1例一期術中端端吻合，2例一期吻合并留置T管支撐，1例行膽囊管結扎，2例內鏡下留置鼻膽管引流，4例術后內鏡下留置膽管支架，6例術后行膽腸Roux-en-Y吻合，1例行脫細胞基質材料修補。隨訪0.3～5年，平均2.3年，效果良好16例，1例反復發生膽管炎。結論醫源性膽管損傷重在預防，精細解剖膽囊三角、嚴格遵循“確認-剪斷-確認”三步驟是防止醫源性膽管損傷的關鍵; 及時發現和正確的處理方法是降低其死亡率及改善預后的關鍵。

Citation： 李曉延,劉其雨,陳剛,王帆,李立. Experience of Diagnosis and Treatment for Iatrogenic Bile Duct Injury During Cholecystectomy in 17 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1321-1322. doi: Copy

1.	中華醫學會外科學分會膽道外科學組. 膽管損傷的預防與治療指南(2008版) [J]. 中華消化外科雜志, 2008， 7（4）: 260266.
2.	Malik AM, Laghari AA, Talpur AH, et al. Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat [J]. Int J Surg, 2008, 6(5): 392395.
3.	Andersson R, Eriksson K, Blind PJ, et al. Iatrogenic bile duct injury-a cost analysis [J]. HPB (Oxford), 2008, 10(6): 416419.
4.	Ali U, Ma ZH, Pan CE, et al. Iatrogenic bile duct injuries from biliary tract surgery [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(3): 326329.
5.	王秉成, 徐元燈. 醫源性膽管損傷原因及診治探討 [J]. 肝膽胰外科雜志， 2004， 16（4）： 306307.
6.	Wauben LS, Goossens RH, van Eijk DJ, et al. Evaluation of protocol uniformity concerning laparoscopic cholecystectomy in the netherlands [J]. World J Surg, 2008, 32(4): 613620.
7.	Downing SR, Datoo G, Oyetunji TA, et al. Asian race/ethnicity as a risk factor for bile duct injury during cholecystectomy [J]. Arch Surg, 2010, 145(8): 785787.
8.	Trnqvist B, Zheng Z, Ye W, et al. Longterm effects of iatrogenic bile duct injury during cholecystectomy [J]. Clin Gastroenterol Hepatol, 2009, 7(9): 10131018.
9.	Saad N, Darcy M. Iatrogenic bile duct injury during laparoscopic cholecystectomy [J]. Tech Vasc Interv Radiol, 2008, 11(2): 102110.
10.	Bhoorasingh P, McCartney T, Simpson LK. Jaundice post laparoscopic cholecystectomy [J]. West Indian Med J, 2010, 59(1): 8891.
11.	Lau WY, Lai EC. Classification of iatrogenic bile duct injury [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(5): 459463.
12.	Wu JS, Peng C, Mao XH, et al. Bile duct injuries associated with laparoscopic and open cholecystectomy: sixteenyear experience [J]. World J Gastroenterol, 2007, 13(16): 23742378.
13.	Karvonen J, Gullichsen R, Laine S, et al. Bile duct injuries during laparoscopic cholecystectomy: primary and longterm results from a single institution [J]. Surg Endosc, 2007, 21(7): 10691073.
14.	張英寶. 醫源性膽管損傷12例報道 [J]. 中國普外基礎與臨床雜志， 2007， 14（5）: 622.
15.	Mercado MA, Chan C, SalgadoNesme N, et al. Intrahepatic repair of bile duct injuries. A comparative study [J]. J Gastrointest Surg, 2008, 12(2): 364368.
16.	Geng L, Luo D, Zhang HC, et al. Microvessel density at different levels of normal or injured bile duct in dogs and its surgical implications [J]. Hepatobiliary Pancreat Dis Int, 2011, 10(1): 8387.

1. 中華醫學會外科學分會膽道外科學組. 膽管損傷的預防與治療指南(2008版) [J]. 中華消化外科雜志, 2008， 7（4）: 260266.
2. Malik AM, Laghari AA, Talpur AH, et al. Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat [J]. Int J Surg, 2008, 6(5): 392395.
3. Andersson R, Eriksson K, Blind PJ, et al. Iatrogenic bile duct injury-a cost analysis [J]. HPB (Oxford), 2008, 10(6): 416419.
4. Ali U, Ma ZH, Pan CE, et al. Iatrogenic bile duct injuries from biliary tract surgery [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(3): 326329.
5. 王秉成, 徐元燈. 醫源性膽管損傷原因及診治探討 [J]. 肝膽胰外科雜志， 2004， 16（4）： 306307.
6. Wauben LS, Goossens RH, van Eijk DJ, et al. Evaluation of protocol uniformity concerning laparoscopic cholecystectomy in the netherlands [J]. World J Surg, 2008, 32(4): 613620.
7. Downing SR, Datoo G, Oyetunji TA, et al. Asian race/ethnicity as a risk factor for bile duct injury during cholecystectomy [J]. Arch Surg, 2010, 145(8): 785787.
8. Trnqvist B, Zheng Z, Ye W, et al. Longterm effects of iatrogenic bile duct injury during cholecystectomy [J]. Clin Gastroenterol Hepatol, 2009, 7(9): 10131018.
9. Saad N, Darcy M. Iatrogenic bile duct injury during laparoscopic cholecystectomy [J]. Tech Vasc Interv Radiol, 2008, 11(2): 102110.
10. Bhoorasingh P, McCartney T, Simpson LK. Jaundice post laparoscopic cholecystectomy [J]. West Indian Med J, 2010, 59(1): 8891.
11. Lau WY, Lai EC. Classification of iatrogenic bile duct injury [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(5): 459463.
12. Wu JS, Peng C, Mao XH, et al. Bile duct injuries associated with laparoscopic and open cholecystectomy: sixteenyear experience [J]. World J Gastroenterol, 2007, 13(16): 23742378.
13. Karvonen J, Gullichsen R, Laine S, et al. Bile duct injuries during laparoscopic cholecystectomy: primary and longterm results from a single institution [J]. Surg Endosc, 2007, 21(7): 10691073.
14. 張英寶. 醫源性膽管損傷12例報道 [J]. 中國普外基礎與臨床雜志， 2007， 14（5）: 622.
15. Mercado MA, Chan C, SalgadoNesme N, et al. Intrahepatic repair of bile duct injuries. A comparative study [J]. J Gastrointest Surg, 2008, 12(2): 364368.
16. Geng L, Luo D, Zhang HC, et al. Microvessel density at different levels of normal or injured bile duct in dogs and its surgical implications [J]. Hepatobiliary Pancreat Dis Int, 2011, 10(1): 8387.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of Diagnosis and Treatment for Iatrogenic Bile Duct Injury During Cholecystectomy in 17 Cases

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