本文選題：膽總管下段　切入點(diǎn)：醫(yī)源性損傷　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討膽總管下段醫(yī)源性損傷易發(fā)因素及其防治措施。方法通過中國知網(wǎng)數(shù)據(jù)庫檢索2000年12月-2015年12月近15年有關(guān)膽總管下段醫(yī)源性損傷的文章,對所有文章進(jìn)行逐一閱讀,篩除不附原始數(shù)據(jù)或同一單位數(shù)據(jù)被重復(fù)引用的文章,最后保留來自28個(gè)單位在各級期刊上發(fā)表的31篇原始文章,共179例作為分析的資料源;從重慶醫(yī)科大學(xué)附屬第一醫(yī)院病案科檢索近15年收治的膽總管下段醫(yī)源性損傷的病例,共8例作為分析的資料源。制作表格,記錄其中的原始數(shù)據(jù),最后進(jìn)行整理分析。結(jié)果膽總管下段醫(yī)源性損傷約90.3%與膽道探查術(shù)有關(guān);膽總管下段損傷病例中膽總管結(jié)石合并結(jié)石嵌頓、黃疸、狹窄的占84.8%,而單純性膽總管結(jié)石只占15.2%;膽總管下段損傷部位以后壁及內(nèi)側(cè)壁為主,分別為55.9%和25.4%,其次為前壁及壺腹部;術(shù)中診斷的膽總管下段損傷79.2%是通過術(shù)者的感知首先予以判斷的,術(shù)后診斷則有54.8%是通過引流液的性狀首先予以判斷的;在術(shù)中發(fā)現(xiàn)的136例膽總管下段損傷的病例中并發(fā)癥發(fā)生率為18.4%,主要為膽漏、腸漏、胰漏、感染、出血,二次手術(shù)發(fā)生率為1.5%。而在術(shù)后發(fā)現(xiàn)的34例膽總管下段損傷病例中,并發(fā)癥發(fā)生率為41.2%,以出血、膽漏、胰漏、感染為主,二次手術(shù)發(fā)生率為17.6%;隨訪年限9月-17年不等,僅2例反復(fù)出現(xiàn)右側(cè)腹痛、腰痛,2例偶發(fā)膽管炎,均為術(shù)后診斷膽管損傷的患者。結(jié)論1.膽總管探查手術(shù)造成的醫(yī)源性膽總管下段損傷占絕大多數(shù);2.膽總管下段特殊的解剖結(jié)構(gòu)、病理結(jié)構(gòu)改變、術(shù)中是否使用膽道鏡都是膽總管下段易損傷的因素;3.術(shù)中術(shù)者的經(jīng)驗(yàn)感知,術(shù)后引流液的性狀對于及時(shí)判斷有無膽管損傷至關(guān)重要;4.術(shù)中及時(shí)發(fā)現(xiàn)及時(shí)處理是治療膽總管下段損傷的最佳時(shí)機(jī),其手術(shù)并發(fā)癥發(fā)生率、住院期間再手術(shù)率、死亡率均較術(shù)后發(fā)現(xiàn)低;5.術(shù)中發(fā)現(xiàn)的膽總管下段損傷無論采取哪種手術(shù)方式都能取得較好的治療效果,術(shù)后發(fā)現(xiàn)的膽總管下段損傷以前期單純引流手術(shù)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.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R657.4

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相關(guān)期刊論文 前2條

1 Varayu Prachayakul;Pitulak Aswakul;;Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention[J];World Journal of Clinical Cases;2014年10期

2 Renato Costi;Alessandro Gnocchi;Francesco Di Mario;Leopoldo Sarli;;Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy[J];World Journal of Gastroenterology;2014年37期

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本文編號：1600084