腹腔镜胆囊切除术胆管损伤修复术后的远期效果观察

目的探讨LC胆道损伤修复术后的远期效果。方法回顾我院1993至2002年收治的27例LC胆管损伤病人的临床资料，结合部分病人随访结果进行分析总结。结果27例病人中，6例经介入方法治愈；21例行手术治疗，其中16例同时进行肝穿刺组织活检；术后1例在20个月时出现轻度吻合口狭窄并发胆管炎，1例在T管拔除之前吻合口近端节段性狭窄，均经气囊扩张治愈；16例行肝穿刺活检的病人中，5例肝组织显著纤维化，其中4例已发展为肝硬化。结论本组平均46个月的随访的病例中，胆肠吻合术的近期有效率为90．5％，远期有效率达100％。反复的盲目修复手术使延误收治的时间平均在16个月后，将导致肝组织损害。

Long-term results of surgical repair for bile duct injury caused by laparoscopic cholecystectomy

Objective To investigate the long-term results of surgical repair for bile duct injury caused by laparoscopic cholecystectomy (LC). Results The clinical data and follow-up results of 27 patients with complex bile duct injury caused by LC treated in our hospital from 1993 to 2002 were retrospectively analyzed. Results Of the 27 patients, 6 underwent interventional therapy and 21 (16 of them also received hepatic biopsy) operative repairing. One patient with cholangitis caused by a mild stricture of the anastomosis in 20 months after operation and the other with segmental duct narrowing proximal to the anastomosis in the postoperative period before T-tube removal were successfully treated by balloon dilatation. Amongst the 16 patients receiving hepatic biopsy, 5 had significant hepatic fibrosis and 4 of them had liver cirrhosis. Conclusions In our series with an average follow-up of 46 months, hepaticojejunostomy (HJ) repair of LC injuries is associated with an initial success rate of 90.5% and an ultimate one of 100%. The repeated blind repair and delayed consultation for an average of 16 months would induce hepatic injury.