28例变异右后叶胆管损伤的诊断与外科治疗

Diagnosis and surgical treatment of aberrant right posterior hepatic bile duct injury： a report of 28 patients

目的探讨变异右后叶胆管损伤的诊断与治疗。方法回顾性分析2002年1月至2011年12月新疆医科大学第一附属医院收治的28例变异右后叶胆管损伤患者的临床资料。根据损伤类型及诊断时间将28例患者分为三组。第一组为10例在第一次术中及时发现变异右后叶胆管损伤并行修补的患者组成；第二组为变异右后叶胆管被缝扎、术后发现的lO例患者组成；第三组为手术中变异右后叶胆管被切断且术后出现胆瘘的8例患者组成。比较患者胆管修复手术后的短期并发症及远期效果。结果第一组患者术后1例出现腹腔积液，无一例出现胆管狭窄；第二组患者术后出现胆瘘1例，腹腔积液2例，切口感染1例，胆道狭窄1例；第三组患者出现胆瘘2例，肠梗阻1例，切口感染2例，腹腔出血1例，随访期间出现胆道狭窄2例，切口疝1例。结论变异右后叶胆管损伤的首次修补是获得成功最珍贵的时机，变异右后叶胆管损伤根据损伤类型及确诊时间可采用多种修复方法。

Objective To review our experience in the diagnosis and surgical management of aberrant right posterior hepatic bile duct injury. Methods Twenty eight patients with aberrant right posterior hepatic bile duct injury treated at the First Affiliated Hospital of Xinjiang Medical University between January 2002 to December 2011 were studied retrospectively. According to the injury type and the time of diagnosis, these patients were divided into three groups. The first group comprised of 10 patients in whom the injury was recognized and repaired at the time of the original surgery. The second group consisted of 10 patients in whom the injured aberrant right posterior hepatic bile duct was diagnosed and treated after operation. The third group comprised of 8 patients who developed an external bile fistula after the aberrant right posterior hepatic bile duct injury. The short and long term complications after surgical repair in the three groups were compared. Results In the first group, 1 patient developed an intra abdominal fluid collection. There was no bile stricture patients in first group. In the second group, 1 patient developed bile fistula, 2 patients intra-abdominal fluid collec tions, 1 patient wound infection, and 1 patient bile duct stricture. In the third group, 2 patients developed bile fistula, 1 patient intestinal obstruction, 2 patients wound infection, 1 patient intra-abdominal hemorrhage, 2 patients bile duct stricture and 1 patient an incisional hernia on follow-up. Conclusions Finding and repairing an aberrant right posterior hepatic bile duct injury at the original operation is the best treatment. According to the type and time of diagnosis, different surgical repair methods can be used for the aberrant right posterior hepatic bile duct injury.