胆管端端吻合、经肝经皮胆道引流术在修复医源性胆管损伤中的应用  

End-to-end bile duct anastomosis and percutaneous transhepatic cholangial drainage for iatrogenic bile duct injuries

作　　者：贾长库[1] 徐孙兵[1] 陈宏伟 陈卫 陈鑫宇 朱含章 刘凌 Jia Changku;Xu Sunbing;Chen Hongwei;Chen Wei;Chen Xinyu;Zhu Hanzhang;Liu Ling(Department of Hepatopancreatobiliary Surgery,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院肝胆胰外科,杭州310000

出　　处：《中华肝胆外科杂志》2022年第2期108-112,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省重症肝胆疾病(移植)诊治技术研究中心项目(JBZX-202004);浙江省肝癌诊治技术研究中心项目(JBZX-201901)。

摘　　要：目的采用胆管端端吻合、经肝经皮胆道引流术修复医源性胆管损伤,评估其临床疗效。方法回顾性分析2012年2月至2021年7月浙江大学医学院附属杭州市第一人民医院收治的因不同手术导致胆管损伤的11例患者的临床资料,其中女性4例,男性7例,年龄(47.5±15.3)岁。11例医源性胆管损伤中Ⅱ1型损伤7例,Ⅱ2型损伤1例,Ⅱ3型损伤1例,Ⅱ1型同时合并Ⅱ2型1例,Ⅱ4型1例。8例为术中发现胆管损伤并给予修复,另外3例修复手术距离初次手术的时间分别为2 d、9 d和5个月。所有患者均利用胆管端端吻合、经肝经皮胆道引流的手术方式进行胆管修复,不放置T型管。结果本组所有胆管损伤的修复手术均1次成功,无死亡病例。2例肝总管端端吻合的患者术后吻合口有胆漏发生,量少:其中1例术后3 d胆漏即消失;另1例经腹腔引流2周后痊愈。其他病例围手术期无胆漏、狭窄等并发症发生,术后肝功能恢复正常,无胆管炎表现。所有病例术后经肝经皮胆道引流通畅,肝表面胆道引流管穿出的部位无胆漏发生,1例在术后6个月拔除胆道引流管,其余病例均是在术后3个月拔除胆道引流管。所有患者术后无腹胀、腹痛、寒战发热、黄疸等症状,实验室检查肝功能正常,影像学检查肝内胆管无狭窄、扩张,工作生活正常,治愈率100%(11/11)。结论医源性胆管损伤修复手术方式应尽量选择胆管端端吻合术,保留Oddi括约肌功能,维持胆汁排泄的正常生理通路;经肝经皮胆道引流能够保障胆管端端吻合修复,能够减低患者的致残分级。Objective A novel bile duct end-to-end anastomosis and percutaneous transhepatic cholangial drainage(PTCD)were designed to treat iatrogenic bile duct injuries,and the clinical efficacy and technical advantage of this combined treatment were analyzed.Methods Clinical data from 11 patients with iatrogenic bile duct injuries treated between February 2012 to July 2021 was retrospectively analyzed.There were 4 females and 7 males,with age of(47.5±15.3)years old.The types of bile duct injuries were:Bismuth type 1(n=7),Bismuth typeⅡ(n=1),Bismuth typeⅢtype(n=1),combined Bismuth type 1 and type 2(n=1),and Bismuth typeⅣ(n=1).Repair operations were performed at the time of the initial surgical procedures in 8 patients.The remaining 3 patients had their repair done 2 days,9 days and 5 months,respectively,after the initial operations.All patients underwent successful bile duct end-to-end anastomosis and PTCD without use of T-tubes.Results All biliary injuries were successfully repaired with no operative mortalities.Two patients who underwent end-to-end anastomosis of common hepatic duct developed anastomotic bile leakage.The amount of bile leakage was small and bile leakage resolved with conservative treatment in 1 patients 3 days after surgery,and was treated successfully by percutaneous peritoneal drainage for 2 weeks in the other patient.There were no other complications,including stricture formation or cholangitis which developed in other patients.All patients’liver functions recovered well.The percutaneous biliary drainage tube was removed 6 months after operation in 1 patient.The remaining patients had their drainage tubes removed 3 months after operation.On follow-up,all patients had no history suggestive of cholangitis,jaundice and other symptoms.The liver functions were normal on laboratory examinations.No stricture or dilatation of intrahepatic bile ducts were detected on imaging examinations.The cure rate was 100%(11/11).Conclusion Surgical repair of biliary tract injuries should aim to preserve sphincter

关 键 词：胆管 创伤和损伤 引流术 

分 类 号：R657.4[医药卫生—外科学]