胆管探查术后的胆管狭窄  

Postcholedochotomy biliary stricture

作　　者：高静涛[1] 李庆怀[1] 曹嘉华[1] 袁克文[1] 李智平[1] 高应鸿[1] 

机构地区：[1]解放军第一医院肝胆外科兰州军区肝胆外科中心,兰州市730030

出　　处：《中华肝胆外科杂志》2005年第9期624-626,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的提出并探讨胆管探查术后胆管狭窄的临床特点、诊治及病因、预防。方法回顾收治的8例胆管探查术后的胆管狭窄病例,分析其临床表现、T管造影、临床病理分型、术中所见及治疗结果。结果8例分别于原T管拔出后数天至数年出现梗阻性黄疸;T管造影示原胆管内径平均为5.9mm;病理分型7例为BismuthⅡ型,1例为Ⅲ型。术中7例可发现狭窄部位线结。Roux-Y胆肠吻合术处理后平均随访超过2年,均未再出现黄疸或发热。结论胆管探查术后胆管狭窄似乎是手术后胆管狭窄的一个特殊类型,有其显著特点,重建术后通常疗效满意。应用导尿管经十二指肠乳头胆道支撑外引流可以十分有效地预防胆管探查术后胆管狭窄的发生。Objective To put forward the postcholedochotomy biliary stricture（PBS） as a special type of postoperative biliary stricture and probe into its clinical features, diagnosis, treatment, etiology and prevention. Methods The clinical data of 8 cases of PBS were retrospectively analyzed with special attention to its clinical features, T tube cholangiography, pathological classification, discovery in operation, and the outcome. Results In all cases the obstructive jaundice developed after withdrawal of the T tube. None of the common bile duct was dilated. 7 cases were type Ⅱ by Bismuth classification, and the other type Ⅲ. In 7 cases the thread knot could be found in the stricture. The outcome of all cases was excellent after the Roux-Y choledochojejunostomy. Conclusions With its own characteristics PBS might be a special type of postoperative biliary stricture, and excellent prognosis could be achieved by Roux-Y eholedoehojejunostomy in most of the cases. Transduodenal stenting of the common bile duct with urinary catheter is quite effective for prevention of PBS.

关 键 词：胆管狭窄 胆管探查 T管 探查术后 临床病理分型 经十二指肠乳头 梗阻性黄疸 T管造影 术中所见 胆肠吻合术 

分 类 号：R657.4[医药卫生—外科学] R657.42[医药卫生—临床医学]