Correct timing of bile duct injury repair
-
摘要: 外科手术是治疗医源性胆管损伤最主要的手段,手术修复时机的正确选择是损伤修复成功的先决条件。详细的阐述了术中发现胆管损伤的即时修复和术后发现的延期修复时机,并根据不同的损伤部位和表现(如胆道梗阻、胆漏和胆胰肠结合部损伤),就延期修复的时机和方法进行了总结和归纳。认为损伤局部的病理状态是决定手术时机的首要因素,修复时机把握的总体趋势是倾向于早期修复,延期修复在炎症得到有效控制后2~4周内尽早实施。Abstract: Surgical operation is the most important method for the treatment of iatrogenic bile duct injury,and correct selection of the timing of surgical repair is a prerequisite for successful injury repair.This article elaborates on the timing of immediate repair of bile duct injury found during surgery and the timing of delayed repair of bile duct injury found after surgery and summarizes the timing and methods for delayed repair based on the location and manifestations of injuries( such as biliary obstruction,bile leakage,and injury in the choledocho-pancreatico- duodenal junction).It is pointed out that the pathological state of injury is the critical factor for deciding surgical timing.The overall tendency of the timing of repair is early repair,and delayed repair should be performed as early as possible within 2- 4 weeks after effective control of inflammation.
-
Key words:
- bile duct diseases /
- surgical procedures
-
[1]TANTIA O,JAIN M,KHANNA S,et al.Iatrogenic biliary injury:13,305 cholecystectomies experienced by a single surgical team over more than 13 years[J].Surg Endosc,2008,22(4):1077-1086. [2]MISAWA T,SAITO R,SHIBA H,et al.Analysis of bile duct injuries(Stewart-Way classification)during laparoscopic cholecystectomy[J].J Hepatobiliary Pancreat Surg,2006,13(5):427-434. [3]WU QS,LIU JJ,XIE WB,et al.Current status of bile duct injury in laparoscopic cholecystectomy[J].Chin J Hepatobiliary Surg,2005,11(3):207-209.(in Chinese)吴青松,刘吉佳,谢文彪,等.腹腔镜胆囊切除术胆管损伤的现状分析[J].中华肝胆外科杂志,2005,11(3):207-209. [4]HUANG XQ,HUANG ZQ.Treatment of iatrogenic bile duct injury[J].Chin J Pract Surg,2001,21(7):413-414.(in Chinese)黄晓强,黄志强.医源性胆管损伤的处理[J].中国实用外科杂志,2001,21(7):413-414. [5]LI HM,GAO ZQ,DOU KF,et al.Treatment of stenosis induced by iatrogenic high bile duct injury:report of 144 cases[J].J Clin Surg,2004,12(3):143-144.(in Chinese)李海民,高志清,窦科峰,等.医源性高位胆管损伤狭窄的处理[J].临床外科杂志,2004,12(3):143-144. [6]JIANG HC,PAN HY.Diagnosis and management of iatrogenic choledocho-pancreatico-duodenal junction injury[J].Chin J Dig Surg,2013,12(1):10-12.(in Chinese)姜洪池,潘华洋.医源性胆胰肠结合部损伤[J].中华消化外科杂志,2013,12(1):10-12. [7]WANG J.Attach importance to the speciality in the diagnosis and treatment of diseases in biliary-pancreatic-duodenal junction[J].Chin J Dig Surg,2012,11(5):419-421.(in Chinese)王坚.提高对胆胰肠结合部疾病诊断和治疗特殊性的认识[J].中华消化外科杂志,2012,11(5):419-421. [8]PENG CH.Intraoperative diagnosis and treatment of iatrogenic injury in choledocho-pancreatico-duodenal junction[J].Chin J Pract Surg,2013,33(5):356-358.(in Chinese)彭承宏.胆胰肠结合部医源性损伤的术中发现与处理[J].中国实用外科杂志,2013,33(5):356-358. [9]WU YV,LINEHAN DC.Bile duct injuries in the era of laparoscopic cholecystectomies[J].Surg Clin North Am,2010,90(4):787-802. [10]WANG J,CHEN W.Application of perihilar surgical techniques in biliary tract surgery[J].Chin J Dig Surg,2015,14(4):284-287.(in Chinese)王坚,陈炜.围肝门外科技术在胆道外科的应用[J].中华消化外科杂志,2015,14(4):284-287. [11] Biliary Surgery Group of Surgery Branch of Chinese Medical Assocaition.Practice guideline for diagnosis and treatment of bile duct injury(2013 edition)[J].Chin J Dig Surg,2013,12(2):81-95.(in Chinese)中华医学会外科学分会胆道外科学组.胆管损伤的诊断和治疗指南(2013版)[J].中华消化外科杂志,2013,12(2):81-95. [12]WANG J,HE M.Surgical treatment of severe abdominal infection caused by injury of the choledocho-pancreatico-duodenal junction[J].Chin J Pract Surg,2009,29(12):1061-1062.(in Chinese)王坚,何敏.胆胰肠结合部损伤致腹腔严重感染的外科治疗[J].中国实用外科杂志,2009,29(12):1061-1062.
本文二维码
计量
- 文章访问数: 2243
- HTML全文浏览量: 13
- PDF下载量: 438
- 被引次数: 0