胆道损伤修复术后再狭窄的治疗:附22例报告  

Management of biliary re-stricture after repair of bile duct injury:a report of 22 cases

作　　者：林先盛[1] 黄强[1] 胡元国[1] 王成[1] 邱陆军[1] 谢放[1] 

机构地区：[1]安徽医科大学附属省立医院普通外科,安徽合肥230001

出　　处：《中国普通外科杂志》2013年第8期1061-1064,共4页China Journal of General Surgery

摘　　要：目的:探讨医原性胆道损伤修复术后再狭窄的治疗。方法:回顾分析2001年1月—2011年12月期间收治的胆道损伤经外院修复后再狭窄的22例临床资料。22例胆道损伤均由胆囊切除所造成,其中8例为腹腔镜胆囊切除术,14例为开腹胆囊切除术。结果:22例患者均再次手术,21例行胆管空肠Roux-en-Y吻合术(1例因胆管损伤位置较高,肝方叶切除后行左右肝管空肠吻合),1例行U管引流术。所有患者经1-11年随访,除1例因胆道感染继发肝功能衰竭死亡外,其他21例患者近远期疗效尚可。结论:胆管损伤发生后应及早修复,注重手术操作的细节,选择合理修复方法;胆管空肠Roux-en-Y吻合术是治疗修复术后再狭窄的可靠术式。Objective：To investigate the management of biliary re-stricture after an initial repair of iatrogenic bile duct injury.Methods：The clinical data of 22 patients with biliary re-stricture after repair of bile duct injury in other hospital admitted from January 2001 to December 2011 were retrospectively analyzed.The bile duct injury in all the 22 cases was caused by cholecystectomy that included 8 cases of laparoscopic cholecystectomy and 14 cases of open cholecystectomy.Results：Reoperations were performed in all the 22 patients,of whom 21 cases underwent Roux-en-Y hepaticojejunostomy（one case underwent quadrate lobectomy due to high injury site of the bile duct,and then anastomosis of the left and right hepatic ducts to the jejunum）,and one case received U-tube external biliary drainage.All patients were followed up for 1 year to 11 years.Except for one patient who died of liver failure caused by biliary infection,all the remaining patients showed relatively positive short-term outcomes.Conclusion：Bile duct injury should be treated as early as possible,and attention to detail during operation and proper selection of repair method is important.Roux-en-Y hepaticojejunostomy is a reliable procedure for biliary re-stricture after repair of the bile duct injury.

关 键 词：胆道外科手术 副作用 医原性疾病 胆汁淤积 吻合术 Roux-en-Y 

分 类 号：R657.4[医药卫生—外科学]