球囊渐进扩张法预防医源性胆管损伤修复后吻合口狭窄

The prophylactic effect of gradual dilatation with biliary balloon dilators on anastomotic stricture after instant hepatojejunostomy for iatrogenic biliary injury

目的探讨应用球囊渐进扩张法治疗医源性胆管损伤及预防术后肝管空肠吻合口狭窄的治疗效果。方法选择28例医源性胆管损伤患者，男15例，女13例，均采用一期肝管空肠吻合手术，术中于吻合口内放置扩张球囊．术后7d开始进行球囊渐进性扩张，根据患者情况每天注气扩张3－4次，逐渐加大注气容量，3个月后拔出球囊导管并随访观察。结果28例患者均完成手术，共使用球囊32支，术后随访6个月。5年，平均2．8年，28例患者术后均未出现腹痛、发热、黄疸、皮肤搔痒等胆管炎及胆管狭窄症状，B超、胆道镜、MRCP检查吻合口无狭窄。结论医源性胆管损伤后．一期手术处理并术中置人扩张球囊、术后渐进扩张的方法可以有效预防术后吻合口狭窄。

Objective To summarize our 5 years experience on management of iatrogenic biliary injury with gradual biliary balloon dilator dilatation, and the prophylactic effect of this method on anastomotic stricture after instant hepatojejunastomy. Methods Twenty-eight patients with bile duct injury were studied during Jan 2003 to Jan 2009. The mean age was 49 years （28-64）, and 15 were male and 13 were female. Hepatojejunastomy immediately （within hours） after the injuries were done for all cases, with the biliary balloon dilators set within the anastamosis. The balloon dilator was dilated with air infusion from the 7th day after operation, started from 3 -4 times/day and then gradually increased based on the situation of individual patient. The balloon dilator was pulled out 3 months after operation and all cases were followed up. Result Hepatojejunastomy were successfully performed in 28 patients and 32 biliary balloon dilators were implanted. The mean follow-up duration was 2.8 years （from 0.5 year to 5 years）. There were no complications of cholangitis and stricture such as recurrent abdominal pain, fever, icterus and itching were found. There＇s also no stricture demonstrated by uhrasonography, cholangioscopy and MRCP examination. Conclusion When bile duct injury occurs instant hepatojejunastomy and biliary balloon dilator implantation accompanied with gradual balloon dilatation afterwards can successfully prevent anastamotie stricture.