返回 2008年第31卷第3期 目录

13例医源性肝外胆管狭窄的处理

袁发秀

（泸州市第二人民医院普外科，四川泸州 646000）

摘 要 目的：探讨医源性胆管损伤的预防及发生肝外胆管狭窄后的手术重建。方法：对13例医源性肝外胆管狭窄的诊断及处理结果进行分析。结果：13例医源性胆管损伤的病人，治愈11例，死亡2例。结论：①影像学检查是了解胆管狭窄病灶的重要手段。B超应为首选，但对于狭窄段的病变程度和范围则有欠缺，MRCP检查能补充B超不足之处，此两项检查能全面显示肝内外胆管树病变部位、程度和范围，以达到完善诊断。②胆管炎发作期间首先要控制感染，经非手术处理症状无改善者应果断采取急诊胆道外引流手术。③肝外胆管狭窄的手术技术要求胆肠合口直径>2.5cm，吻合口无张力，血运良好，空肠袢长度40~45cm，无扭曲悬吊。对于胆管扩张，缝合技术可靠，吻合口足够大者可不置放T管支架引流，但胆管扩张不明显，管壁增厚僵硬，炎症未得到控制或行左右肝管成形，左肝管扩大切开者应置放T管或Y形支架管，时间不少于6个月。

关键词 医源性胆管损伤；胆管狭窄；手术

THE SURGICAL MANAGEMENT OF 13 CASES OF IATROGENIC EXTRAHEPATIC BILE DUCT STRICTURE

Yuan Faxiu

Department of General Surgery,the Second People's Hospital of Luzhou City

Abstract Objective：To study the prevention and operational treatment of iatrogenic extrahepatic bile duct stricture.Methods：A retrospective of 13 patients suffered iatrogenic extrahepatic bile duct stricture was conducted. In this study, the methods for diagnosis and treatment were reviewed and analyzed.Results:11 out of 13 cases were cured,whereas 2 patients died .Conclusions：Firstly,imaging examination plays an important role in diagnosis of extrahepatic bile duct stricture.Ultrasound should be the first choice,while the MRCP could contribute to the more accurate diagnosis. Secondly,bacterial cholangitis needs to be cured prior to surgery . Acute surgical treatment has to be employed if little improvement is acquired with conservative therapy.Additionally, the technical considerations of the hepaticojejunostomy Roux-en-Y are as follows :anastomotic stoma >2.5cm;no tension at anastomotic stoma; rich blood supply for anastomotic stoma,non-twist of Roux-en-Y loop at the length of 40~45cm. It is supported to insert T or Y tube into anastomotic stoma in presence of thickened biliary wall, narrow hepatic duct , or post-hepatoplasty.

Key words Latrogenic bile duct injury；Biliary stricture;Surgery