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医源性损伤性胆管狭窄的外科治疗 被引量:4

Surgical treatment of iatrogenic traumatic biliary stricture
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摘要 医源性损伤性胆管狭窄是胆道外科的难题之一,目前手术仍是其惟一的确定性治疗手段[1].但若手术时机选择不当、治疗方法欠妥或修复技术存在缺陷,初期的胆管损伤将演变成复杂的高位胆管狭窄,继发胆管结石、复发性胆管炎,甚至进展为不可逆的胆汁性肝硬化、肝功能衰竭,给患者造成灾难性损害.本研究回顾性分析1998年1月至2011年12月我院收治的173例医源性损伤性胆管狭窄患者的临床资料,旨在探讨其外科治疗的方法. Iatrogenic traumatic biliary stricture is one of the difficult points in the biliary surgery, and operation is the only definitive treatment. The operative opportunity, surgical procedure and techniques are important for the prognosis. From January 1998 to December 2011, 173 patients with iatrogenic traumatic stricture were admitted to the Eastern Hepatobiliary Surgery Hospital. According to the Bismuth classification of traumatic biliary stricture, 10 patients were in type Ⅰ , 22 in type Ⅱ, 87 in typeⅢ, 38 in type Ⅳ and 16 in type Ⅴ. Excision of the traumatic stricture with end-to-end anastomosis was performed on 19 patients. Of the 173 patients, 154 were treated by Roux-en-Y duodenojejunostomy, and 8 of them received additional hemihepatectomy or partial hepatectomy. A total of 155 patients were followed up, with a median time of 74 months, the total excellent and good rate was 94.8% (147/155). Surgery is the most effective therapy for iatrogenic traumatic biliary stricture. Optimal timing, reasonable surgical methods, strictly following the principle of biliary surgery and perfect operative skills are key points for a better prognosis.
出处 《中华消化外科杂志》 CAS CSCD 北大核心 2012年第5期448-451,共4页 Chinese Journal of Digestive Surgery
关键词 胆管狭窄 胆管损伤 医源性 外科手术 Biliary strictures Biliary injury, iatrogenic Surgical procedures, operative
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