腹腔镜胆囊切除术胆管损伤修复术后的远期效果观察  

Long-term results of surgical repair for bile duct injury caused by laparoscopic cholecystectomy

作　　者：郭永学 

机构地区：[1]江门市人民医院,广东省529000

出　　处：《中华肝胆外科杂志》2005年第9期596-598,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨LC胆道损伤修复术后的远期效果。方法回顾我院1993至2002年收治的27例LC胆管损伤病人的临床资料,结合部分病人随访结果进行分析总结。结果27例病人中,6例经介入方法治愈;21例行手术治疗,其中16例同时进行肝穿刺组织活检;术后1例在20个月时出现轻度吻合口狭窄并发胆管炎,1例在T管拔除之前吻合口近端节段性狭窄,均经气囊扩张治愈;16例行肝穿刺活检的病人中,5例肝组织显著纤维化,其中4例已发展为肝硬化。结论本组平均46个月的随访的病例中,胆肠吻合术的近期有效率为90.5%,远期有效率达100%。反复的盲目修复手术使延误收治的时间平均在16个月后,将导致肝组织损害。Objective To investigate the long-term results of surgical repair for bile duct injury caused by laparoscopic cholecystectomy （LC）. Results The clinical data and follow-up results of 27 patients with complex bile duct injury caused by LC treated in our hospital from 1993 to 2002 were retrospectively analyzed. Results Of the 27 patients, 6 underwent interventional therapy and 21 （16 of them also received hepatic biopsy） operative repairing. One patient with cholangitis caused by a mild stricture of the anastomosis in 20 months after operation and the other with segmental duct narrowing proximal to the anastomosis in the postoperative period before T-tube removal were successfully treated by balloon dilatation. Amongst the 16 patients receiving hepatic biopsy, 5 had significant hepatic fibrosis and 4 of them had liver cirrhosis. Conclusions In our series with an average follow-up of 46 months, hepaticojejunostomy （HJ） repair of LC injuries is associated with an initial success rate of 90. 5% and an ultimate one of 100%. The repeated blind repair and delayed consultation for an average of 16 months would induce hepatic injury.

关 键 词：胆囊切除术 腹腔镜 胆管损伤 远期效果 远期效果观察 修复术后 腹腔镜胆囊切除术 吻合口狭窄 肝穿刺活检 肝组织损害 穿刺组织活检 

分 类 号：R657.4[医药卫生—外科学]