胆管损伤术后胆管狭窄54例分析

Surgical management of injurious biliary stricture and clinical analysis

目的探讨胆管损伤性狭窄的原因，外科治疗以及疗效。方法回顾性分析我院1987年至2007年损伤性胆管狭窄54例患者临床资料。结果54例损伤处理后平均5．6个月内均不同程度的狭窄。对症治疗8例，内镜治疗7例，胆道探查5例，肝总管十二指肠侧侧吻合1例，胆总管空肠侧侧吻合1例，胆管空肠Roux—Y吻合32例。预后评估参照MeDon分类，本组失访6例，随访48例中共43例（79．6％）（A=35，B=8）长期疗效良好，5例（9．2％）（C=5）术后疗效差。结论损伤性胆道狭窄首选胆管空肠Roux—Y吻合，其中胆管连续性尚存的低位早期狭窄也可选内镜治疗，效果良好。

Objective The aim of present study was to assess the surgical management, result and cause of injurious biliary stricture. Methods A retrospective survey on 54 patients with biliary stricture treated in our institution from 1987 to 2007. Result After bile duct injury,All the patients had different levels of stricture at an average of 5.6 months after primary repair. And symptomatic treatment in 8 patients, endoscopic treatment in 7 patients, common bile duct exploration in 5 patients, side - to - side hepatico- duodenostomy in 1 patient, side - to - side choledochojejunostomy in 1 patient, Roux - Y cholangio - jejunostomy in 32 patients . The overall outcome of 54 patients with completed treatment was excellent in 35 patients and good in 8. Five had to return to hospital intermittently, six lost to follow - up. Conclusion Roux- Y cholangio- jejunostomy is preferred in biliary stricture, and endoscopic therapy also had good result in low bile duct stricture with continuity in early stage.