自体组织修复在肝门胆管良性狭窄的临床应用

Application of autogenous tissue flap in repair of benign bile duct stricture

目的探讨自体组织瓣治疗肝门胆管良性狭窄的方法及疗效。方法回顾性分析32例肝门胆管良性狭窄的治疗及其预后。其中肝总管狭窄14例,右肝管狭窄4例,左肝管狭窄9例,左右肝管汇合部狭窄5例。手术方法:带蒂胆囊瓣修复肝门胆管良性狭窄21例,肝圆韧带脐静脉片修复肝门胆管良性狭窄7例,带蒂胃壁修复肝门胆管良性狭窄4例。结果4例患者出现围手术期手术并发症(12.5%),均自愈。随访全部病例均存活,手术效果总优良率89.7%;3例术后2年狭窄复发,改行胆肠吻合术后效果良好。结论自体组织修复肝门良性狭窄总体效果良好,其中带蒂胆囊瓣可作为首选的修复材料。在肝胆管结石术中,若胆囊无明显病变应予保留,以备远期修复使用。

Objective To study the autogenous tissue flap in repair of benign hilar biliary stricture.Methods Prognosis of 32 patients with benign hilar biliary stricture after repaired with autogenous tissue flap was retrospectively analyzed.Of the 32 patients,14 had common hepatic duct stricture,4 had right hepatic duct stricture and 5 had left hepatic stricture.The stricture was repaired with gallbladder pedical flap,umbilical vein graft,and stomach tissue pedical flap in 21,7,and 4 patients,respectively.Results Complications occurred in 4 cases（12.5%） after operation,which were disappeared with no treatment.All the 32 patients survived.The total effective rate was 89.7%.The stricture recurred in 3 patients 2 years after operation,which was treated with biliary-enteric anastomosis.Conclusion Autogeneous tissue pedical flap can achieve a rather good outcome in repair of benigh hilar bililary stricture with gallbladder graft pedicle flap as the first choice.The gallbladder with no significant lesion should be preserved during the procedure for its future use.