胆管损伤与损伤性胆管狭窄修复的相关问题探讨  

Related issues in repair of bile duct injury and traumatic biliary stricture

作　　者：王曙光[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《临床肝胆病杂志》2017年第2期256-259,共4页Journal of Clinical Hepatology

摘　　要：胆管损伤与损伤性胆管狭窄处理不当将引发反复胆管炎、肝胆管结石形成、胆汁性肝硬化等严重后果。论述了胆管损伤及狭窄修复疗效的影响因素、修复的原则、修复或重建的时机及方式和技术。认为损伤局部无明显炎症且胆管壁缺损<2 cm,应力争对端吻合修复;如缺损>2 cm,应进行胆管空肠吻合重建。胆管壁上壁缺损过多而下壁连续性完整,可利用带蒂脐静脉瓣或带蒂空肠壁浆肌瓣或胃壁浆肌瓣进行修复。损伤局部充血水肿严重者应行损伤胆管充分外引流,择期修复或重建。肝叶或肝段肝管狭窄并伴有肝组织萎缩可行肝叶或肝段切除。强调显露并解除肝门胆管高位狭窄是修复成功的关键,而肝Ⅳb段切除能够充分显露左右肝蒂,有助于切开左右肝管及二级肝管,是显露高位狭窄胆管的良好方法。Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis,formation of hepatolithiasis,and biliary cirrhosis.This article elaborates on the influencing factors for the effect of the repair of bile duct injury and traumatic biliary stricture,repair principles,timing of repair or reconstruction,and related methods and techniques.It is pointed out that if there is no significant local infection and the bile duct wall defect is〈 2 cm,end- to- end anastomosis should be used for repair;if the bile duct wall defect is 〉2 cm,Roux- en- Y hepaticojejunostomy should be used for reconstruction.If the upper wall of the bile duct had a large defect and the lower wall has an integral structure,pedicled umbilical vein graft,pedicled jejunal wall seromuscular flap,or gastric wall seromuscular flap should be used for repair.The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction.Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy.The key to successful repair is exposure and removal of high hilar bile duct stricture,while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts,and therefore,it is a good method for exposing high bile duct stricture.

关 键 词：胆管疾病 胆管炎 修复外科手术 

分 类 号：R657.4[医药卫生—外科学]