肝肠吻合联合胆管支撑管置入术在BismuthⅢ、Ⅳ型肝门部胆管狭窄外科修复中的应用

Application of hepatoenterostomy combined with biliary stents in the surgical repair of Bismuth Ⅲ and Ⅳ hilar bile duct stricture

目的初步探讨肝肠吻合联合胆管支撑管置入术在BismuthⅢ、Ⅳ型肝门部胆管狭窄修复中的应用价值。方法回顾性收集2008年10月至2020年10月期间因BismuthⅢ、Ⅳ型肝门部胆管狭窄于华中科技大学同济医学院附属协和医院行肝肠吻合联合胆管支撑管置入术的患者14例,所有患者均符合纳入排除标准。收集患者一般资料、既往病史、临床资料、术后住院时间、并发症发生率及术后复发情况等。结果根据Bismuth分级对胆管狭窄的患者进行分类,BismuthⅢ级3例,BismuthⅣ级11例。良性病变10例,继发于胆管损伤的胆管狭窄8例,其中医源性损伤7例,腹部创伤1例;炎症性狭窄2例,其中胆管炎1例,炎性假瘤1例。恶性病变4例,均为肝门部胆管癌。14例患者均顺利完成手术,其中12例行腹腔镜下肝肠吻合联合胆管支撑管置入术,2例因严重腹腔粘连中转开腹;无围手术期死亡患者。1例患者发生术后胆瘘,保守治疗后缓解,围手术期无其他并发症发生。在随访期间,所有患者生活质量良好。结论肝肠吻合联合胆管支撑管置入术在治疗复杂肝门部胆管狭窄中具有一定应用价值。

objective To explore the application value of hepatoenterostomy combined with biliary stents in the surgical repair of BismuthⅢandⅣhilar bile duct stricture.Methods A total of 14 patients with BismuthⅢandⅣhilar bile duct stricture,who underwent hepatoenterostomy combined with biliary stents in Huazhong University of Science and Technology Tongji Medical College Affiliated Union Hospital from Oct.2008 to Oct.2020,were retrospectively analyzed.All patients met the inclusion and exclusion criteria.The general data,past medical history,clinical data,postoperative hospital stay,complication rate and postoperative recurrence were collected.Results According to the Bismuth grade,the patients with biliary stricture were classified,including 3 cases of BismuthⅢand 11 cases of BismuthⅣ.There were 10 cases of benign lesions,including 8 cases of bile duct stenosis secondary to bile duct injury(7 cases of iatrogenic injury and 1 case of abdominal trauma)and 2 cases of inflammatory stenosis(1 case of cholangitis and 1 case of inflammatory pseudotumor).Four cases of malignant lesions were hilar cholangiocarcinoma.All the 14 patients successfully completed the surgery(12 cases underwent laparoscopic hepatoenterostomy combined with biliary stents and 2 cases were converted to open surgery due to severe abdominal adhesions)and no perioperative death occurred.One patient developed postoperative biliary fistula,which was relieved after conservative treatment,and no other complications occurred during the perioperative period.During the follow-up period,all patients had good quality of life.Conclusion Hepatoenterostomy combined with biliary stents has certain application value in the treatment of complex hilar bile duct stenosis.