胆管损伤修复术后胆管狭窄的处理

Treatment of postoperative biliary stricture after bile duct reconstruction

目的 探讨胆管损伤修复术后胆管狭窄的治疗方法。 方法 回顾分析 3 2例胆管损伤修复术后 16例胆管再次狭窄的临床资料 ,12例再次行胆管空肠Roux -en -Y吻合术、4例原Roux -en -Y吻合口扩大再行盆式吻合术。 结果 全部病例获随访 ,2例术后出现肝脏转氨酶ALT升高 ,给予保肝治疗 ,1月后均恢复正常。余 1例随访 0 5年 ,4例 1年～ 3年 ,3例 3年～ 5年 ,6例 >5年 ,无黄疸、无胆管炎症状发作。 12例术后 1年B超检查扩张的胆管减小 0cm～ 0 5cm 5例 ,0 5cm～1cm 7例。

ObjectiveTo explore the treatment of postopera tive biliary strictu re after bile duct reconstruction.MethodsA retrospective rev iew of clinical data of 16 patients with postoperative biliary stricture after bile duct reconst ruction was made. Out of the 16 patients, Roux-en-Y choledocho-jejunostomy was p erformed in 12 patients, and expanding of the anastomotic stoma combined with he patico-jejunostomy in 4 patients.ResultsAll the patients wer e followed up. T he transaminase (ALT) in 2 patients was elevated postoperatively, and their ALT levels returned to normal 1 month after liver-protection treatment. Of the remai ning 14 cases, the duration of follow-up were 6 months in 1 case, (1～3) years i n 4 cases, (3～5) years in 3 cases, and >5 years in 6 cases, respectively. No jau n dice or cholangitis were seen during the follow-up. B-ultrasound examinations in 12 cases 1 year after the operation revealed a decrease of (0～0 5) cm in bile d uct diameter in 5 cases, and (0 5～1 0) cm in 7 cases.Conclusions Reoperation in the treatment of postoperative biliary stricture after bile duct reconstructi on is satisfactory.