高位胆管良性狭窄的原因和治疗

Reasons for and treatment of non-malignant stricture in high bile ducts

目的 探讨高位胆管良性狭窄的原因和防治。方法 回顾性总结分析高位胆管良性狭窄 4 6 0例的病因和治疗方法。结果 病因依次为肝胆管结石 (383例 )、高位胆管损伤 (5 4例 )、胆囊结石Mirizzi综合征 (2 1例 )、单纯良性狭窄 (2例 )。分别行肝叶或肝段切除 ;经肝剖开狭窄胆管 ,肝胆管或肝门胆管空肠吻合 ;肝门胆管狭窄切开整形后与空肠大口吻合 ;吻合口狭窄切开扩大吻合 ;肝门胆管狭窄切开整形后T管支撑等手术。效果满意 ,优良率为 90 1%。结论 高位胆管良性狭窄的主要原因是肝胆管结石 (83 3% )和高位胆管损伤 (11 7% )。肝叶或肝段切除 ,或联合肝内胆管或肝门胆管空肠大口吻合是治疗肝胆管结石并肝胆管狭窄的有效方法。高位胆管损伤初期修复后较易发生胆管或吻合口狭窄 ,再次修复以胆管空肠Roux en Y大口吻合术效果最好。强调重在预防 ,在行胆道手术时避免胆管损伤。

Objective To explore the reasons for and treatment of non-malignant stricture in high bile ducts. Methods The reasons for and treatment of non-malignant stricture in high bile ducts were retrospectively analyzed in 460 patients. Results The reasons for the non-malignant stricture in high bile ducts were calculus in hepatobiliary ducts in 383 cases, high hepatobiliary tract injury in 54, Mirrizi syndrome in 21 and non-malignant scar stricture in 2. Operations for its treatment included lobe or segment hepatectomy, incision of bile ducts with stricture through the liver parenchyma, hepatic bile duct or hilar biliary duct-jejunostomy, hilar bile duct plasty and T-tube drainage etc. The curative rate was 90.1%. Conclusions The main reasons for non-malignant stricture in high bile ducts are calculus in hepatobiliary ducts (83.3%) and high hepatobiliary duct injury (11.7%). Lobe or segment hepatectomy together with hepatic bile duct or hilar biliary duct-jejunostomy is the best choice for treatment of calculus in hepatobiliary ducts complicated with stricture. High bile duct injury is the main reason for hilar bile duct non-malignant stricture and hilar bile duct-jejuno large intestine anastomosis is the best choice for its treatment.