临床误诊误治2017，Vol.30Issue(4)：18-21,4.DOI:10.3969/j.issn.1002-3429.2017.04.006
Mirizzi综合征手术致胆管损伤随访近16年报告并文献复习
Biliary Duct Injury Induced by Surgery for Mirizzi Syndrome with Follow-up for 16 Years: a Report and Literature Review
肖青川 1胡红强 1秦红军 1时吉庆 1李佳俊1
作者信息
- 1. 14000 四川 乐山,武警四川总队医院肝胆一外科
- 折叠
摘要
Abstract
Objective To investigate treatment strategies and preventive measures of complex iatrogenic bile duct injury.Methods Process of clinical diagnosis and treatment for a Mirizzi syndrome patient with bile duct injury induced by surgery, who was followed for 186 months, was retrospective analyzed, and related literature was reviewed.Pathogenesy reasons, prosthodontic treatment timing and methods and the criteria of judging curative effect were analyzed.Results The patient underwent open cholecystectomy for gallstone accompanied with chronic atrophic cholecystitis, and Mirizzi syndrome (type I) was confirmed during surgery.Definitive reconstructive surgery was implemented because of serious adhesion and bile were found in the operative visual fields, and bile duct transection was found at 0.5 cm below the junction point of the left and right hepatic ducts after careful observation, and the surgery achieved good effect with 5 years of follow-up.Biliary stricture was observed in postoperative 6th year, and then following excision of diseased bile duct, reconstruction of bile duct and choledochojejunostomy were conducted.Anastomotic stricture and left liver atrophy were found in 3 years later, and then removal of biliary-intestinal anastomosis, excision of left liver, reconstruction of the right hepatic duct and second choledochojejunostomy were conducted.No obviously uncomfortable symptoms were found during followed up for 3 years.Conclusion The main causes of iatrogenic bile duct injury are the carelessness of surgical physicians and the complexity of patients' pathological changes.It's suggested that definitive surgeries should be implemented positively by experienced specialists after considering generally physical conditions and the well local circumstance of the diseased bile duct of patients, and follow-up visit time should be at least 20 years.关键词
胆管疾病/胆囊切除术/手术后并发症/医源性问题Key words
Bile duct diseases/Cholecystectomy/Postoperative complications/Iatrogenic problems分类
医药卫生引用本文复制引用
肖青川,胡红强,秦红军,时吉庆,李佳俊..Mirizzi综合征手术致胆管损伤随访近16年报告并文献复习[J].临床误诊误治,2017,30(4):18-21,4.
