闭合性肝外伤导致高位胆管狭窄患者的手术治疗  

Surgical approach for patients with high biliary stricture caused by blunt liver trauma

作　　者：于良[1] 师建华[1] 王博[1] 孙昊[1] 郝杰[1] 

机构地区：[1]西安交通大学医学院第一附属医院肝胆外科,710061

出　　处：《中华肝脏外科手术学电子杂志》2013年第4期7-9,共3页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：陕西省科技统筹创新工程计划项目(2011KTCL03-21)

摘　　要：目的探讨闭合性肝外伤导致高位胆管狭窄患者的手术治疗方法。方法回顾性分析2007年1月至2011年12月西安交通大学医学院第一附属医院收治、由闭合性肝外伤导致的3例高位胆管狭窄患者的临床资料。其中男2例，女1例，按就诊先后顺序，3例患者年龄分别为42、29、34岁。患者均签署知情同意书，符合医学伦理学规定。患者以闭合性肝外伤手术后黄疸逐渐加重入院，伴腹痛、发热和碱性磷酸酶升高。3例患者行计算机体层摄影术（CT）、磁共振胰胆管成像（MRCP）、内镜下逆行性胰胆管造影术（ERCP）、经皮经肝胆道造影术（PTC）检查，诊断为Bismuth分型Ⅳ型胆管狭窄。3例患者入院后多次行内镜下鼻胆管引流术或ERCP支架植入术，疗效欠佳，分别于闭合性肝外伤手术后65、73、94d，采用Hepp．Couinaud法高位胆管．空肠吻合术重建胆道。结果3例患者手术顺利。1例患者术后4d出现轻微胆漏，给予加强引流处理，治愈出院。另2例术后无并发症，恢复良好出院。随访时间分别为3、14、37个月。无胆管狭窄或胆管炎复发。结论对于闭合性肝外伤导致的高位胆管狭窄患者，在多次介入治疗失败后，应及时行Hepp．Couinaud法高位胆管．空肠吻合术重建胆道。外科手术治疗的最佳时机可能是闭合性肝外伤修复术后2～3个月。Objective To investigate the treatment for patients with high biliary stricture caused by blunt liver trauma. Methods Clinical data of 3 patients with high biliary stricture caused by blunt liver trauma in the First Affiliated Hospital, School of Medicine, Xi＇an Jiaotong University from January 2007 to December 2011 were analyzed retrospectively. There were 2 males and 1 female with the age of 42, 29 and 34 years old respectively according to the sequence of hospitalization. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients were hospitalized due to gradually aggravated jaundice, accompanied by abodominal pain, fever and elevated alkaline phosphatase after operations of blunt liver trauma. Three patients received computed tomography （CT）, magnetic resonance cholangiopancreatography （MRCP）, endoscopic retrograde cholangiopancreatography （ERCP） and percutaneous transhepatic cholangiography （FFC）, and were diagnosed as biliary stricture of Ⅳ type of Bismuth. Three patients received repeated endoscopic nasobiliary drainage or ERCP stent placement, and the curative effect was poor. The Hepp-Couinaud eholangiojejunostomy was performed to reconstruct the bile duct in 3 patients on 65^th, 73^th and 94^th d respectively after the operation of blunt liver trauma. Results All the operations were successful. One patient suffered mild bile leakage 4 d after operation and was cured by enhanced drainage. The other 2 cases recovered well and were discharged without complications. The patients were followed up for 3, 14, 37 months and no recurrence of biliary stricture or cholangitis were observed. Conclusions For the high biliary stricture patients caused by blunt liver trauma, Hepp-Couinaud cholangiojejunostomy should be performed to reconstruct the bile duct after repeated failure of interventional treatments. The best operation time may be 2-3 months after the repair operation for blunt liver trauma.

关 键 词：闭合性肝外伤 腹部损伤 高位胆管狭窄 胆管肠吻合术 肝 

分 类 号：R657.4[医药卫生—外科学]