肝外胆管近端损伤即时处理的若干经验

SOME EXPERIENCE ABOUT URGENT MANAGEMENT OF TRAUMA OF PROXIMAL EXTRAHEPATIC BILE DUCT.

目的 探讨治疗肝外胆管近端损伤的有效方法。方法 回顾性分析联合应用稀疏缝合、吻合部短期内支撑 ,以及术后持续低负压吸引技术治疗 5例肝外胆管近端损伤的临床资料 ,并对各例进行长期随访。结果 5例术后早期均未发生胆漏及腹腔感染等并发症。经长达 8个月至 10年的随访 ,各例均无与胆道有关的不适症状及黄疸 ;B超复查各例均无肝组织萎缩及硬化征象 ,肝内、外胆管无扩张、无结石 ;肝功能均正常。结论 肝外胆管近端损伤后即时 ,在行修复手术及治程中 ,联合应用缝合、支撑、吸引技术可有效预防肝管—肝管吻合及肝管 -空肠 Roux- Y吻合术的近。

Objective To explore the effective treatment on trauma of proximal extrahepatic bile duct. Methods Clinical materials of five patients treated with the combined technology which is composed of sparse suture with thin thread, short term stent on the anastomotic stoma and sustained suction with micro negative pressure are retrospectively analyzed. All of five cases have been followed up for a long time.Result The complications, such as biliary leakage and abdominal infection ,were not discovered among these five cases after the operation. All of them have been followed up for 8 months to 10 years. We discover that none of them got the uncomfortable symptom associated with bile duct and jaundice. And the B us shows that no one developed liver atrophy and hepatocirrhosis,their internal external hepatic bile ducts are not dilated. The liver function test is normal Conclusions The combined technology may be effectively used for treating the trauma of proximal extrahepatic bile duct to prevent a variety of complications after hepatic hepaticnostomy and Roux Y hepticojejunostomy.