气囊U管粘膜移植术治疗胆道损伤性狭窄

在欧美广泛应用Smith式粘膜移植法处理医源性损伤后的胆道狭窄,但术后部分病人仍可出现再狭窄。作者时Smith法加以改进,定名为“气囊U管粘膜移植法”。其特点是:①肠粘膜的开口与肝管的口径相同;②使用U管;③在U管上附加一只气囊以防止肠漏及胆漏,又可在适当时拉入胆道,对吻合口进行扩张。临床使用效果良好,是一种简易有效而安全的方法。

BALLOON U TUBE MUCOSAL GRAFT: AN IMPROVED TECHNIQUE FOR REPAIR OF HIGH BILE DUCT STRICTURE

The Smith mucosal graft technique has been widely adopted in the Western countries in the treatment of iatrogenic high bile duct stricture. The procedure is easy to perform with a high success rate. Nevertheless, re-stricture may occur in some patients. The most likely cause lies in the so small an opening in the jejunal mucous membrane that it can only accommodate the transhepatic catheter.An improved procedure has been designed and named"Balloon U tube mucosal graft". Preliminary clinical application has proved it to be satisfactory. The characteristics of this procedure are (l)the opening in the jejunal mucous membrane should be as large as that of the hepatic duct for anastomosis. (2) the U tube technique should be employed. (3) a balloon has to be attached to the U tube to prevent intestinal or/and bile leakage and to dilate the anastomosis stoma as well when it is drawn into the bile duct in ductcourse.This new technique can provide surgeons with a simple, safe and effective approach in dealing with difficult cases due to high bile duct stricture.