不同手术应用胆管对端吻合术疗效分析

Curative effect of choledo-choledochostomy in different operations

目的通过观察不同胆道重建方式在医源性胆管损伤和肝移植中的应用，探讨胆管对端吻合法的疗效。方法分别回顾分析昆明医学院第二附属医院10年来术中发现胆管横断性损伤并及时修复的19例临床资料和66例肝移植临床资料，并对其胆道重建方式进行探讨。结果胆管对端吻合法在医源性胆管损伤术中的效果优良率达86．6％，肝移植术中供受体胆管端端吻合是否留置T管对其疗效无显著性差异（P〉0．05）。结论胆管对端吻合术在肝移植供受体胆管重建术、医源性胆管损伤中有较好的疗效，术中不必过分游离胆管，以保证吻合口的血供良好，可进一步提高疗效。

Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver transplant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenic bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation （P〉0.05）. Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further enhance the curative effect.