带蒂胆囊瓣修复治疗肝门部胆管狭窄的临床体会

Clinical experience in restoring stenosed hilar bile duct by gall- bladder lamella with cystic artery

目的探讨带血管蒂的胆囊瓣修复肝门部胆管狭窄的手术方法。方法利用自体胆囊制成带胆囊动脉的组织瓣，在狭窄胆管广泛切开、扩大成形的基础上，修复胆管壁缺损。结果肝内胆管结石合并胆管狭窄10例，胆管镜取石致右肝管损伤1例，左肝内胆管癌侵及左肝管1例。随访至今，全组病例术后无胆漏，未出现返流性胆管炎，无结石复发。结论本术式保留了Oddis括约肌的生理功能，同时达到了解除狭窄和畅通引流的目的，是一种较为理想的手术方式。

Objective To investigate the surgical procedure of restoring stenosed hilar bile duct by gall- bladder lamella with cystic artery. Methods Based on extensive incising and hilar cholangioplasty, stenosed hilar bile duct was restored by gallbladder lamella with cystic artery. Results Among all the 12 pa- tients, including 10 intrahepatic bile duct calculi patients, 1 right hepatic duct injury and 1 left intrahepatic chaolangiocarcinoma, no cystic fistula, reflexed cholangitis and recurrent stone were noticed by post operative follow-up. Conclusion This procedure is a ideal method by remaining the normal function of Oddis sphincter while removing stenosis.