医源性晚期胆管狭窄的起因和处理

Cause and management of late iatrogenic biliary duct stricture

本组医源性晚期胆管狭窄的76例病例中63例，是胆囊切除或胆道探查手术损伤所致，其中曾行一次或多次胆管修复无效者38例，隐性胆管损伤远期发生狭窄14例，胆道探查“T”管引流后期胆管狭窄11例；因胆肠吻合术的适应证选择不当或吻合口狭窄13例。胆管损伤的早期修复的关键是根据不同情况选择恰当的修复术式，缝合技术准确精细，吻合口宽大、无张力，避免胆漏和感染。晚期胆管狭窄的手术处理宜首选胆管空肠Roux—en—Y吻合，本组病例远期优良效果达87％。肝门区高位胆管损伤性狭窄或缺损显露肝门部胆管困难时，可劈开肝中裂显露。

The main cause of 76 patients with late binary duct stricture was iatrogenes injuries. Of which, the injuries of 63 xases were arised from cholecystectomy or choledchotomy. Among these cases, the cause of biliary duct strictrue were as follows:failing in repair of the damaged biliary duct one time and again in 38 cases, the long term biliary duct stricture due to conceal injury during operation in 14 cases,the late biliary duct stricture after choledochotomy and 'T 'tube drainage in 11, anastomotic stoma stricture after choledochoenterostomy or choice of inadequate dochoenterostomy in 13 case. In the early stage of biliary duct injury. The key point of repair procedure is choice of adequate operative modality according to the individual conditions. The careful operative technique, the wide anastomotic stoma of cholangiojejunostomy, and the avoiding bile leakge and infection are important. In the late stage of duct stricture, the Roux-en-y clolangiojejunostomy is selected firstly.The excellent long tirm rate of this operation is account for 87%. when the duct stricture of defect situale to the high hlus of the liver, the preferable method to expose bile duct is spliting the middle line of the liver parenchyma.