复杂损伤性胆管狭窄的治疗  

Surgical treatment for iatrogenic biliary stricture with severe abdominal infection

作　　者：程志雷[1] 王敬[1] 

机构地区：[1]解放军总医院肝胆外科医院、全军肝胆外科研究所,北京100853

出　　处：《中华消化外科杂志》2012年第5期444-447,共4页Chinese Journal of Digestive Surgery

摘　　要：医源性胆管损伤发生率较高,其手术处理的目的是使患者获得较高的生命质量.多次手术干预不但会增加患者痛苦,而且增加后续手术的难度并降低确切性修复手术的成功率.因此,临床决策每一步都应当慎重,做到精准诊断和治疗.本研究回顾性分析2012年5月29日我院收治的1例复杂损伤性胆管狭窄患者的临床资料,探讨该病的外科治疗策略.Biliary stricture after cholecystectomy posesdifficult management problems to surgeons because of high and stable incidence. In contrast to malignant stricture, benign stricture requires durable repair. Repeated operations may not only increase the suffering of the patient, but also reduce the likeli- hood of a better outcome. A 56-year-old woman with biliary stricture after cholecystectomy who had undergone several operations in other hospitals was admitted to Chinese PLA General Hospital. Computed tomography （CT） scan showed a dilated biliary tree and localized the level of ductal obstruction in the hepatic hilar stricture. In addition, CT identified fluid collections in the left upper quadrant and no artery injury was detected. Uhrasound-guided percutaneous abdominal drainage was performed to control the abdominal infection. Magnetic resonance cholangiopancreatography classified the injury as Bismuth Ⅲ. The patient with bile leakage and severe abdominal infection was treated with antibiotics before the final operation. On June 1, 2012, the patient received Roux-en-Y hepaticojejunostomy. After operation, the patient recovered smoothly without severe complications, such as bile leakage, cholangitis and recurrent stricture. Liver function of the patient was back to normal and T tube drainage was pulled out at the end of 3 months of follow up.

关 键 词：胆管狭窄 胆管损伤 医源性 外科手术 

分 类 号：R657.4[医药卫生—外科学]