胆道术后良性胆管狭窄合并胆管结石的治疗措施(附1例报告)  

Treatment of Biliary postoperative benign bile duct stricture combined with bileduct calculus(with one case report)

作　　者：金旺德 金星林 Jin Wangde;Jin Xinglin(Hepatobiliary and Pancreatic Surgey,The Hospital of Yanbian University,Yanji Jilin 133000,China)

机构地区：[1]延边大学附属医院肝胆胰外科,延吉133000

出　　处：《河南外科学杂志》2025年第2期13-15,共3页Henan Journal of Surgery

摘　　要：胆道取石术后胆管可能发生变形、成角及良性狭窄(BBS),造成胆汁排出不畅,引起结石复发。经内镜逆行胰胆管造影术(ERCP)+经内镜Oddis括约肌切开取石术(EST)虽然是首选的治疗手段,但部分患者可能因解剖变异而导致手术失败;再次胆道探查取石术后仍可能发生BBS、结石复发,若联合胆肠吻合术则因丧失了Oddis括约肌功能,极大增加了胆道感染的概率,且可能因吻合口狭窄、胆汁排出不畅,引起结石复发。对胆道术后BBS并发肝胆管结石的患者,本研究实施胆管切开取石,胆管内置入自膨式金属覆膜支架,胆管切口I期缝合术,旨在防止术后再次发生BBS及结石复发。After biliary lithotomy,the bile duct may experience deformation,angulation,and benign biliary stricture(BBS),which can lead to impaired bile drainage and subsequent recurrence of stones.Endoscopic retrograde cholangiopancreatography(ERCP)combined with endoscopic sphincterotomy of the Oddi's sphincter(EST)is the preferred treatment approach.However,in some patients,the surgery may fail due to anatomical variations.Even after repeated biliary exploration and lithotomy,BBS and stone recurrence remain possible.When combined with cholangioenterostomy,the loss of the Oddi's sphincter function significantly increase the risk of biliary tract infection.Additionally,anastomotic stricture and impaired bile drainage may also trigger stone recurrence.For patients with BBS complicated by hepatolithiasis after biliary surgery,this study implemented bile duct incision for lithotomy,followed by the implantation of self-expandable covered metallic stents within the bile duct and primary suture of the bile duct incision.The aim is to prevent the recurrence of BBS and stones after the operation.

关 键 词：良性胆管狭窄 自膨式金属覆膜支架 胆管结石 

分 类 号：R657.4[医药卫生—外科学]