胆管损伤的外科重建

Surgical reconstruction of the bile duct injuries

各种原因导致的胆管损伤所引起的胆汁漏、胆道梗阻及其继发的远期严重并发症是威胁患者生命安全的临床难题。通过确定性的外科手术重建胆汁的消化道引流仍然是目前临床上解决这一难题的主要治疗手段。成功的胆道重建主要依赖于术者丰富的胆道外科经验和精准的胆道外科技术。术者在施行任何确定性手术前，都应仔细评估与损伤有关的细节并确定胆管损伤的分型，以此为依据选择合理的手术时机和手术方式。吻合应建立在无炎症、无缺血、无瘢痕的健康胆管是重建手术的基本原则。手术的核心步骤包括近远端胆管的显露、吻合胆管的组织制备以及组织吻合。建立通畅胆汁引流的、无张力、血供充足的黏膜对黏膜吻合是外科重建的终极目标。

Various bile duct injuries caused bile lea- kage or biliary obstruction and severe secondary long-term com- plications which threaten patients＇ survival. At present, confir- mative surgeries to reconstruct bile flow into gastrointestinal tract remains as a major resort to treat bile duct injury. Successful reconstruction mainly depends on experienced surgeons armed with precisely biliary surgical technology. Surgical repair should be based on cautious preoperative assessment and identification of bile duct injury. The basic principle of reconstruction includes that anastomosis is performed on the healthy bile duct with sufficient blood supply and without inflammation, ischemia and scar. The core of reconstruction includes the exposure of proximal and distal bile ducts and preparation of materials for repair and anas- tomosis. The definite goal of this surgery is to build up an unobstructed biliary drainage, tension-free mucosa with sufficient blood supply for mucosa anastomosis.