带蒂胆囊瓣或脐静脉瓣修复胆管损伤的体会

The Clinical Experience of Bile Duct Defect Reconstruction by Pedicled Cholecyst Valve or Umbilical Vein Graft

目的总结带蒂胆囊瓣和脐静脉瓣修复肝外胆管缺损的临床经验。方法回顾性分析我院2000～2010年采用带蒂胆囊瓣或脐静脉瓣修复肝外胆管缺损8例的临床资料。结果本组术后常规行逆行胆管造影检查,均提示胆管通畅,无狭窄及残余结石;B超检查示胆管轻度扩张5例,无异常3例。术后出现胆瘘2例,经1～2周引流痊愈。术后3个月内2例M irizzi综合征反复出现胆管炎症状,经对症治疗后痊愈。胆管引流管均于术后6～12个月经夹管观察后拔除,未出现不适。本组均痊愈出院,随访3～5年,无胆管疾病复发。结论带蒂胆囊瓣或脐静脉瓣修复肝外胆管损伤疗效确切、安全可行,但要注意把握好手术适应证并掌握手术要点。

Objective To summarize clinical experience in surgery of bile duct reconstruction with pedicled cholecyst valve or umbilical vein graft.Methods 8 patients admitted to our hospital during 2000 and 2010 underwent surgery of bile duct reconstruction with pedicled cholecyst valve or umbilical vein graft from,and their clinical data was retrospectively analyzed.Results All the patients were routinely examined with the postoperative retrograde cholangiography and showed no bile duct patency,stenosis or residual stones.B-ultrasonic examination indicated that there was slight expansion of bile duct in 5 cases and no abnormality in 3 cases.Postoperative biliary fistula occurred in 2 cases,who recovered 1 to 2 weeks after drainage.Within 3 months after surgery,2 patients with Mirizzi syndrome had recurrent cholangitis and were cured by symptomatic treatment.Biliary drainage tubes were removed 6 to 12 months after surgery and no patients complained of indisposition.All patients were cured and a follow-up of 3 to 5 years showed no bile duct disease recurrence.Conclusion Bile duct reconstruction with pedicled cholecyst valve or umbilical vein graft is an efficient and safe procedure for reconstruction of bile duct defects.However,it requires strict indications and good operational skills.