目的:探讨门静脉高压症(Portal hypertension,PHT)合并胆石症的合理处理方式。方法:回顾分析2003年9月于2008年9月64例PHT合并胆石症患者不同方式手术治疗的结果。根据手术方式不同将64例患者分为三组。A组:仅行胆道手术(n=20);B组:在行PHT手术的同时行胆道手术(n=20);C组:在行PHT手术时对胆囊或胆道结石未作处理(n=24)。结果:死亡率A组10%,B组28.5%,C组4.3%。并发症:A组40%,B组70%,C组25%。结论:PHT合并胆石症无论仅行胆道手术或同期行PHT手术和胆道手术,手术死亡率和术后并发症均显著增加,尤以同期手术为明显。根据患者情况选择正确的手术方式,可有效降低手术风险。
Objective To explore the measures for early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 20 patients with iatrogenic injury in the distal part of common bile duct treated in our hospital from 1990 to 2008 were analyzed retrospectively. Results The injuries of 15 cases were found during the operation: 11 cases were treated with 3-stoma (bile duct, pancreas, duodenum)+Oddi sphinctreoplasty (OSP), 1 case with OSP+choledochojejunostomy, 2 cases with the perforated common bile duct suture repair+T tube drainage, 1 case with T tube drainage; All of them were cured after surgery. The other 5 cases were not found during the primary operation, 2 cases in which were cured with several operations, the other 3 were dead from infectious shock. Conclusions Early diagnosis and treatment of iatrogenic injury in the distal part of common bite duct can obtain perfect effects. Different procedures should be performed according to different degrees of the injury. The perfect preoperative imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.