损伤性肝外胆管狭窄的诊断和治疗

Diagnosis and treatment of traumatic extra-hepatic bile duct stricture

目的探讨损伤性肝外胆管狭窄的诊断方法和治疗效果。方法回顾性分析2000-2009年间损伤性肝外胆管狭窄21例的临床资料。结果 B超、CT、MRCP和ERCP是确诊肝外胆管狭窄常用的诊断方法。高位狭窄12例,其中6例为修复后再狭窄;低位狭窄9例。16例施行肝胆管-空肠Roux-Y吻合术,3例施行肝胆管-十二指肠间置空肠吻合术,2例施行胆总管-十二指肠侧侧吻合术。1例术后发生吻合口胆漏,经持续低负压吸引治愈。无死亡病例。全组均随访1年以上,其中10例已5年以上,均效果良好(95.23%)。结论肝外胆管狭窄一经诊断明确,即应考虑手术治疗;若胆管有急性炎症,应在炎症得到控制1个月后尽早手术为妥;肝胆管-空肠Roux-Y吻合是最常用的手术。

Objective To explore the diagnostic method and effect of surgical treatment of traumatic extra-hepatic bile duct stricture.Methods A retrospective analysis of the clinical data of traumatic extra-hepatic bile duct stricture in 21 cases was done.Results BUS,CT,MRCP,MRCP were common used diagnostic methods.High stricture was found in 12 cases,among which 6 cases were biliary re-stricture after repair for bile duct injury,lower stricture in 9 cases.Roux-Y hapeticocholangiojejunostomy were performed in 16 cases,hapeticocholangioduodenostomy with jejunum interposition in 3 cases and side to side choledochoduodenostomy in 2 cases.There was transient anastomotic leak in 2 case and were cured by negative pressure drainage.Followed-up for more than one years in all cases and for more than 5 years in 10 cases,all had good effect（95.23%）.Conclusion When the diagnosis of extra-hepatic bile duct stricture is definiteness,the operation should be performed.The operation should be performed in one month after acute cholangitis was controlled and the operative fashion of most common used is Roux-Y hepato-cholangiojejunostomy.