高位胆管损伤性狭窄的原因及防治  

Causes,Prevention and Treatment of Traumatic Stricture of High Bile Duct

作　　者：魏东[1] 张小文[2] 朱红[2] 戈佳云[2] 吴雪松[2] 王炳煌[2] 

机构地区：[1]昆明医学院临床技能中心,云南昆明650031 [2]昆明医学院第二附属医院肝胆外科,云南昆明650101

出　　处：《昆明医学院学报》2009年第2期133-136,共4页Journal of Kunming Medical College

摘　　要：目的探讨高位胆管损伤性狭窄的常见原因和防治方法,以期提高手术疗效,减少并发症.方法回顾性总结分析收治的25例高位胆管损伤性狭窄的临床资料.全组病例均有不同程度的胆管炎、黄疸、肝功能异常,其中肝硬化、门静脉高压4例,凝血功能异常者2例.高位胆管损伤性狭窄25例(其中22例外院转入),行肝(肝门)胆管充分切开、整形与空肠袢Roux-y大口径吻合或盆式吻合,经修复重建后随访22例,随访时间6个月～6a,随访率为88.0%(22/25).结果随访期内3例因吻合口狭窄再次扩大吻合获得治愈,总优良率为92.0%.结论医源性胆管损伤是高位胆管损伤性狭窄的主要原因,采用肝(肝门)胆管充分切开、整形与空肠Roux-y大口径吻合或盆式吻合是治疗的最佳术式,术中注意胆管的显露及吻合方法可提高疗效,减少狭窄再发生率.医疗活动中,杜绝医源性胆管损伤是预防高位胆管损伤性狭窄的主要途径.Objective To explore the common causes and methods of prevention and treatment for traumatic stricture of high bile duct so as to improve surgical curative effects and reduce complications. Methods The clinical data of 25 cases with traumatic stricture of high bile duct from 2001 to 2007 were summarized retrospectively. Different levels of cholangeitis, jaundice and liver disfunction were observed in the whole group, among which there were 4 cases of hepatic cirrhosis and portal hypertension and 2 cases of blood clotting disfunction. 25 cases of traumatic stricture of high bile duct, including 22 cases transferred from other hospitals, were performed full discission and reshaping for hepatic bile duct or hepatic portal bile duct and Roux-y large caliber or basin-shaped anastomosis with jejunum. 22 patients were followed up for 6 months to 6 years and the follow-up rate was 88.0% （22/25）. Results 3 cases were cured by re-enlarging the anastomosis due to stoma stricture during the follow-up period. The total excellence rate accounted for 92.0%. Conclusions Iatrogenic bile duct injure is the major cause of traumatic stricture of high bile duct. The best treatment is full discission and reshaping for hepatic bile duct or hepatic portal bile duct and Roux-y large caliber or basin-shaped anastomosis with jejunum. Attention should be paid during the surgery to the revealment of bile duct and anastomosis methods in order to improve the curative effects and decrease the recurrence rate of the stricture. Avoiding iatrogenic bile duct injuries is the major approach to prevent traumatic stricture of high bile duct in curative activities.

关 键 词：高位胆管 损伤性狭窄 防治 

分 类 号：R657.46[医药卫生—外科学]