胆总管下段医源性损伤易发因素及防治探讨

发布时间：2018-03-11 22:02

本文选题：胆总管下段　切入点：医源性损伤　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探讨胆总管下段医源性损伤易发因素及其防治措施。方法通过中国知网数据库检索2000年12月-2015年12月近15年有关胆总管下段医源性损伤的文章,对所有文章进行逐一阅读,筛除不附原始数据或同一单位数据被重复引用的文章,最后保留来自28个单位在各级期刊上发表的31篇原始文章,共179例作为分析的资料源;从重庆医科大学附属第一医院病案科检索近15年收治的胆总管下段医源性损伤的病例,共8例作为分析的资料源。制作表格,记录其中的原始数据,最后进行整理分析。结果胆总管下段医源性损伤约90.3%与胆道探查术有关;胆总管下段损伤病例中胆总管结石合并结石嵌顿、黄疸、狭窄的占84.8%,而单纯性胆总管结石只占15.2%;胆总管下段损伤部位以后壁及内侧壁为主,分别为55.9%和25.4%,其次为前壁及壶腹部;术中诊断的胆总管下段损伤79.2%是通过术者的感知首先予以判断的,术后诊断则有54.8%是通过引流液的性状首先予以判断的;在术中发现的136例胆总管下段损伤的病例中并发症发生率为18.4%,主要为胆漏、肠漏、胰漏、感染、出血,二次手术发生率为1.5%。而在术后发现的34例胆总管下段损伤病例中,并发症发生率为41.2%,以出血、胆漏、胰漏、感染为主,二次手术发生率为17.6%;随访年限9月-17年不等,仅2例反复出现右侧腹痛、腰痛,2例偶发胆管炎,均为术后诊断胆管损伤的患者。结论1.胆总管探查手术造成的医源性胆总管下段损伤占绝大多数;2.胆总管下段特殊的解剖结构、病理结构改变、术中是否使用胆道镜都是胆总管下段易损伤的因素;3.术中术者的经验感知,术后引流液的性状对于及时判断有无胆管损伤至关重要;4.术中及时发现及时处理是治疗胆总管下段损伤的最佳时机,其手术并发症发生率、住院期间再手术率、死亡率均较术后发现低;5.术中发现的胆总管下段损伤无论采取哪种手术方式都能取得较好的治疗效果,术后发现的胆总管下段损伤以前期单纯引流手术效果最好。
[Abstract]:Objective to investigate the common bile duct injury Yiyuan predisposing factors and prevention measures. Methods by Chinese HowNet database retrieval -2015 December 2000 December for nearly 15 years under the section of common bile duct injury Yiyuan articles, one by one to read all the articles, not excluding the same unit of raw data or data is repeatedly quotes the last remaining 31 original articles from 28 units at all levels published in journals, a total of 179 cases as the analysis data retrieval source; the last 15 years were from the First Affiliated Hospital of Chongqing Medical University Medical Record Department of the common bile duct Yiyuan injury cases, a total of 8 cases as the analysis of the data source. The production of tables, records of the original data. The final results were analyzed. The common bile duct injury Yiyuan about 90.3% with common bile duct exploration; common bile duct injury of common bile duct stones complicated with incarcerated stones, yellow Jaundice, stenosis accounted for 84.8%, and the simple common bile duct stones accounted for only 15.2%; common bile duct injury after the wall and inner wall, respectively 55.9% and 25.4%, followed by the front wall and ampulla; common bile duct surgery in the diagnosis of injuries in the lower part of 79.2% is the patient's perception to judge first the postoperative diagnosis is 54.8% is to be judged first by drainage of fluid properties; the complications of 136 cases of common bile duct in operation under the period of injury incidence was 18.4%, mainly for bile leakage, intestinal leakage, pancreatic leakage, infection, hemorrhage, two surgery occurred in 34 cases of common bile duct rate 1.5%. found in the postoperative period under the injury cases, the complication rate was 41.2%, with bleeding, bile leakage, pancreatic leakage, infection, surgery two times the incidence rate was 17.6%; in September -17 years follow-up, only 2 cases of recurrent right abdominal pain, back pain, 2 cases were sporadic cholangitis. The diagnosis of bile duct damage after operation The patients with iatrogenic bile duct. Results 1. common bile duct surgery under the injury accounted for the vast majority of 2. common bile duct; special anatomy, pathological changes, whether the use of intraoperative choledochoscopy are common bile duct damage factors; perceptual experience 3. surgeons. The drainage fluid properties for timely judgment without bile duct injury is crucial; 4. patients in the timely detection and timely treatment is the best time for the treatment of bile duct injuries in the lower part, the incidence rate of complications during hospitalization, reoperation rate, mortality were found low; found 5. intraoperative injury of common bile duct or what kind of surgery can achieve better therapeutic effect, postoperative found common bile duct injury in early simple surgical drainage effect is the best.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.4

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