肝门胆管良性狭窄个体化治疗的临床研究

目的 前瞻性地评价肝门胆管良性狭窄的处理方式与近远期疗效的关系。方法 前瞻性观察了按病因不同分为4组的25例患者，分别以不同方式治疗所取得的近远期疗效。结果 肝门胆管空肠吻合术治疗良性医源性肝门胆管狭窄疗效确切，随访期间返流性胆管炎1例，发生率较低，仅为10%，肝门胆管原位整形保持了胆管生理学的完整性，惟需可用的良好的自体修补组织及合理的手术设计两个因素；含石的萎缩右半肝切除加肝门胆管整形既达到了清除病灶的目的，又保持了胆管的通畅性及生理功能的完整性；气囊扩张虽对轻度环形狭窄有良效，但继发性硬化性胆管炎伴肝门管状狭窄气囊扩张疗效欠佳。结论 根据不同病因选择各异的治疗方案（个体化），处理肝门胆管良性狭窄可获近远期良效。

PATHOGEN BASED MANAGEMENTOF BENIGN HILAR STRICTURE OF BILE DUCT

Objective To evaluate the linkage between the proxmal as well as long term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis. Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.