胆总管探查并T管引流术后胆管狭窄再手术23例临床分析

Reoperation of bile duct stricture after common bile duct exploration and T-tube drainage operation with clinical analysis 23 cases

目的探讨常规开腹胆总管探查、T管引流术后发生胆管狭窄的特点、原因以及再手术处理。方法回顾性分析中国人民解放军总医院肝胆外科1990-2005年间收治的因常规开腹胆总管探查、T管引流术后胆管狭窄并再手术的23例良性胆管狭窄的病例资料,对其既往手术史、此次就诊、再手术及疗效情况加以总结分析。结果23例胆管狭窄首次诊断均为胆囊结石、单纯胆总管结石,既往有1～3次手术史。狭窄分型以BismuthⅠ型和Ⅱ型为主,其中Ⅰ型7例（30.4%）;Ⅱ型8例（34.8%）,Ⅲ型4例（17.4%）;Ⅳ型4例（17.4%）。手术方式修复手术和胆肠吻合各11例（47.8%）,介入治疗1例（4.3%）。随访13例病人中胆道修复和胆肠吻合术疗效均为优良,1例介入治疗病人因长期胆道梗阻致肝功能衰竭死亡。结论肝门部胆管是极易受损的部位,不可轻视常规经典胆总管探查、T管引流手术不当所带来的严重并发症。

Objective To investigate the characteristic, causes and treatment of bile duct stricture after conventional open common bile duct （CBD） exploration, T-tube drainage operation. Methods The clinical data of 23 cases of bile duct stricture after conventional open CBD exploration,T-tube drainage operation in General Hospital of PLA from 1990 to 2005 were analyzed, and the previous operation, current diagnosis and treatment outcome of those cases were summarized and analyzed. Results Diagnosis of 23 cases of bile duct stricture for the first time was cholecystolithiasis. There were 1 to 3 times of operative history. Stricture level ：There were 7 cases of Bismuth level Ⅰ （ 30. 4% ） ,8 cases of Bismuth level Ⅱ （34. 8% ） ,and 4 cases of Bismuth level Ⅲ and Ⅳ （ 17.4% ）, respectively. Operative mode： There were 11 cases （47. 8% ） of repair operation and cholangio-intestinal anastomosis operation respectively as well as one ease （4.3%） of interventional therapy. Among 13 cases of follow-up, the effects of repair operation and cholangio-intestinal anastomosis operation were both excellent;there was one case of interventional therapy dead with liver function failure because of longterm bile tract obstruction. Conclusion Hilar bile duct is the site where is very easy to be injured. So the severe complication derived from inappropriate, conventional, classical and open common bile duct （CBD）exploration,T-tube drainage operation should not be neglected.