90例损伤性胆管狭窄患者手术时机及手术效果的临床回顾性分析

Clinical retrospective analysis of operation time and operation effect of 90 patients with traumatic biliary strictures

目的：回顾性分析损伤性胆管狭窄患者手术时机对手术效果的影响。方法回顾性分析安阳市人民医院损伤性胆管狭窄患者90例，根据手术时间将上述患者分为 A 组（损伤3个月内手术）、B 组（损伤3个月后手术），对上述患者采取间置胆管十二指肠吻合术、肝门部胆管整形胆管空肠γ型吻合术、带蒂组织瓣修复术，比较两组患者不同手术时机、手术方式的临床效果，并观察并发症危险因素。结果 A 组治愈率（91.84%）高于 B 组（75.61%），差异有统计学意义（P ﹤0.05）；三种术式治疗优率分别为70.00%、76.47%、66.67%，差异未见统计学意义（P ﹥0.05）；共25例患者出现严重并发症，包括广泛渗血6例，顽固性腹水4例，切口裂开感染5例，肝功能不全9例，肺炎并胸腔积液1例，并发症组年龄、血清胆红素、黄疸时间较非并发症组显著较高（P ﹤0.05），血清白蛋白水平则显著较低（P ﹤0.05）。结论损伤性胆管狭窄患者建议早期行胆道修复手术，但具体设定仍需结合患者实际情况，若患者具备手术条件，则应尽早行胆管修复重建术。

Objective To retrospectively analyze the influence of operation timing on operation effect of patients with traumatic bile duct stricture. Methods Retrospective analyzed the 90 patients with biliary stricture injury in Anyang People’s hospital,according to the operation time,the patients were divided into group A（damage inside March surgery） and group B（damage in March after surgery）. All patients took interposition choledochoduodenostomy,hilar bile duct airγ type plastic intestinal anastomosis,pedicle flap reconstruction. The clinical effects of patients with different timing of op-eration,operative methods were compared,and the risk factors of complications were observed. Results The cure rate in group A（91. 84% ）was higher than that in group B（75. 61% ）,the difference was significant（P ﹤ 0. 05）;excellent rates of three surgical treatment were 70% ,76. 47% ,66. 67% ,there was no significant difference（P ﹥ 0. 05）;a total of 25 patients with serious complications,including extensive bleeding in 6 patients,4 patients with intractable ascites,5 cases of wound dehiscence and infection,liver dysfunction in 9 cases,pneumonia and pleural effusion in 1 case,complications age,serum bilirubin and jaundice time was significantly higher than non complication group（P ﹤ 0. 05）,serum albumin levels were significantly lower（P ﹤ 0. 05）. Conclusions Early Biliary stenosis of biliary tract surgery are suggested in patients,but the specific setting still need to combined with actual situation,if it has surgical conditions,so should be as early as possible taken bile duct reconstruction.