球囊渐进扩张法用于医源性胆管损伤一期修复的临床研究  

Role of gradual dilatation with biliary balloon dilators in the primary repair of iatrogenic biliary injury

作　　者：程龙[1] 田伏洲[2] 刘永康[3] 骆助林[2] 任建东[2] 向珂[2] 王瑞丰[2] 

机构地区：[1]成都军区空军都江堰航空医学鉴定训练中心 [2]成都军区总医院全军普通外科中心,成都610083 [3]成都军区452医院普外科

出　　处：《腹部外科》2013年第5期306-309,共4页Journal of Abdominal Surgery

基　　金：中国博士后科学基金资助项目（No.2012M512183）

摘　　要：目的 探讨球囊渐进扩张法用于医源性胆管损伤一期修复的效果.方法 将76例医源性胆管损伤患者分为球囊组（36例）与对照组（40例）.球囊组采用一期胆肠吻合及球囊置入术,术后进行球囊渐进扩张3个月;对照组采用传统一期胆肠吻合术,术后T管支撑6个月.结果 术后球囊组吻合口狭窄的发生率（2.8%,1/36）显著低于对照组（15.0%,6/40）（P〈0.05）.对照组与球囊组术后胆漏的发生率分别为5.0%（2/40）与8.3%（3/36）,胆道出血的发生率分别为2.5%（1/40）与2.8%（1/36）,胆管炎的发生率分别为10.0%（4/40）与8.3%（3/36）,两组间差异均无统计学意义（P〉0.05）.结论 球囊渐进扩张的治疗方法用于医源性胆管损伤的一期修复是安全的,且可以有效预防术后吻合口狭窄.Objective To investigate the clinical efficacy of gradual balloon dilatation in the pri mary repair of iatrogenic biliary injury. Methods Seventy six patients with iatrogenic hiliary injury were divided into two groups： balloon group （n = 36） and control group （n = 40）. Patients in balloon group underwent hepatojejunastomy immediately （within hours） after the injuries were diagnosed, with the biliary balloon dilators set within the anastamosis. The balloon dilator was dilated with air in- fusion from the 7th day after operation for 3 months. In the control group, patients were subjected to hepatojejunastomy with T tube stenting in the anastomotic stoma for 6 months. Results While the in cidence of cholangitis, bile leakage and biliary bleeding were comparable between the two groups, the incidence of anastomotic stricture in balloon group （2. 8G, 1/36） was significantly lower than that in the control group （15.0%, 6/40） （P〈0.05）. Conclusion Hepatojejunastomy and biliary balloon di- lator implantation accompanied with gradual balloon dilatation afterwards was safe and can successfully prevent anastamottc stricture.

关 键 词：手术中并发症 胆管 创伤和损伤 球囊扩张法 胆管空肠吻合术 

分 类 号：R657.4[医药卫生—外科学]