胆道术后胆道良性狭窄17例临床分析  

Clinical analysis of 17 patients with benign biliary stricture after biliary surgery

作　　者：杨强[1] 张爱民[1] 陈晓燕[1] 叶子 邢志祥[1] 沈世强[1] Yang Qiang;Zhang Aimin;Chen Xiaoyan;Ye Zi;Xing Zhixiang;Shen Shiqiang.(Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Chin)

机构地区：[1]武汉大学人民医院肝胆外科,武汉430060

出　　处：《腹部外科》2018年第1期48-51,共4页Journal of Abdominal Surgery

摘　　要：目的分析胆道术后发生胆道良性狭窄的原因及诊治情况,提高其防治水平。方法回顾性分析武汉大学人民医院2015年1月至2016年6月胆道术后胆道良性狭窄病人17例,对其病因、诊断及治疗进行分析。结果 17例病人中,11例病人因术中医源性胆管损伤导致术后狭窄,3例病人因T管拔除过早导致术后狭窄,3例病人因其他不明原因导致术后狭窄。其中行支架置入治疗7例,行狭窄部成形治疗2例,胆管空肠Roux-en-Y吻合治疗5例,行狭窄部球囊扩张治疗3例。17例病人术后3d较术前血清总胆红素及主要症状明显改善(P<0.05),且均恢复良好出院。术后随访6个月至2年,15例病人无任何胆道系统症状;2例病人偶尔有短暂症状,但无需治疗;无病人出现明显与胆道系统有关且需要进一步治疗的症状,总体效果良好。结论胆道术后胆道良性狭窄主要原因为术中医源性胆管损伤,但仍有部分病人狭窄原因不明,应在术中积极预防医源性胆管损伤。胆道术后胆道良性狭窄以胆总管下段和肝门部狭窄为主,治疗方法主要包括手术治疗和介入治疗,选择合适的治疗方法可以有效提高临床治疗效果。Objective To analyze the etiology,diagnosis and therapy of benign biliary stricture after biliary surgery and improve curative and preventive effects.Methods The clinical data of 17 cases of benign biliary stricture after biliary surgery in Renmin Hospital of Wuhan University from January 2015 to June 2016 were retrospectively analyzed.Results Of all the 17 patients,there were 11 cases of postoperative biliary stricture caused by iatrogenic bile duct injury,3 cases caused by earlier removal of T tube,3 cases caused by other unknown reasons.The postoperative biliary stricture was treated by stent implantation（7 cases）,by modification of strictures（2 cases）,by bile duct jejunum Roux-en-Y anastomosis（5 cases）,and by persistent balloon dilatation（3 cases）.The total bilirubin and main symptoms of the 17 patients were significantly lower/milder than those before operation（P〈0.05）,and all of them recovered well.Fifteen of the patients had no postoperative biliary symptoms,2 of the patients had transient symptoms,and none of the patients had symptoms significantly associated with biliary tract and needing further treatment.The overall effect was good.ConclusionsThe benign biliary stricture after biliary surgery is mainly caused by iatrogenic bile duct injury,but there are still some patients whose cause is unknown,so it is necessary to prevent iatrogenic bile duct injury during the operation.Benign biliary stricture after biliary surgery is mainly located in the lower segment of common bile duct and hepatic portal bile duct.The treatment of benign biliary stricture mainly includes surgical treatment and interventional therapy.The appropriate method can effectively improve the therapeutic effect.

关 键 词：胆道术后 胆道良性狭窄 临床分析 

分 类 号：R657.4[医药卫生—外科学]