Repair of benign bile duct stricture

Cases of benign bile duct stricture treated during the past ten years were reviewed in reference to the location of the bile duct stricture, the method of repair and their long-term results. Common hepatic duct was the most frequent site of bile duct involved. Bilioenteric anastomosis in the form of retrocolic hepaticojejunostomy (Roux-Y) was the method of repair most frequently used. Brief survey was made on the current literatures concerning the methods of repair of benign bile duct stricture.     

良性胆管狭窄支架治疗研究进展

<正>良性胆管狭窄（benign biliary stricture,BBS）多见于胆囊切除术后、肝移植术后、胆道手术后、慢性胰腺炎及原发性硬化性胆管炎等,胆管损伤的修复和愈合是以广泛的瘢痕形成和纤维化为特征~[1],处理不当时可导致胆管狭窄甚至完全闭塞,出现反复发作的胆管炎及梗阻性黄疸,如长期未经有效治疗,将产生肝损害、肝纤维化,甚至导致胆汁性肝硬化和门静脉高压,预后不良。良性胆管狭窄治疗首先选择创伤小、     

肝门胆管良性狭窄的原因和处理

目的：探讨单纯肝门胆管良性狭窄的原因和治疗。方法：回顾性总结分析单纯肝门胆管良性狭窄73例的病因,治疗方法和效果。结果：病因依次为肝胆管结石（48例）,高位胆管损伤（19例）,胆囊结石Mirizzi征（4例）,单纯良性瘢痕性狭窄（2例）,分别施行了肝门胆管空肠吻合,肝门胆管整形,肝门胆管切除等手术87例次,随访1－19年61例次的远期效果,优良77％,好转6．6％,差16．4％,其中,以肝门胆管空肠吻合效果最好,优良达90．7％,结论：肝门胆管良性狭窄的主要原因是肝胆管结石和高位胆管损伤,治疗以肝门胆管空肠大口吻合效果最好。     

良性胆管狭窄行胆肠Roux-en-Y吻合术后再手术临床分析

目的 探讨良性胆管狭窄行胆肠Roux-en-Y吻合术后再手术的原因和再手术的方法.方法 回顾性分析良性胆管狭窄行胆肠Roux-en-Y吻合术后28例再次手术患者的临床资料.文中数据统计分析计量资料采用t检验,多因素分析采用Stepwise logistic回归分析.结果 再次手术原因为残余结石合并胆管狭窄10例,单纯吻合口狭窄11例,胆管狭窄6例,吻合口漏和十二指肠漏1例.再手术方式为:肝叶或肝段切除+胆肠Roux-en-Y吻合术18例,肝正中裂劈开+胆肠Roux-en.Y吻合术5例,右半肝切除术1例,吻合口狭窄段切除+胆肠Roux-en-Y吻合术1例,腹腔引流+十二指肠造瘘+空肠造瘘术1例,胆管切开取石+T管引流术2例,术后发生并发症13例.结论 胆道再手术病情复杂,手术难度高,详细了解病情和正确的手术方式是良性胆管狭窄再手术成功的关键.     

A case of benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma

We report a patient with benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma. A 66-year-old woman consulted a local physician because of general fatigue. Blood biochemical tests showed increased levels of biliary tract enzymes. Abdominal ultrasonography (US) revealed tapering and blockage of the midportion of the bile duct and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) demonstrated obstruction of the midportion of the bile duct. Later, because a marked increase in biliary tract enzymes and jaundice appeared, percutaneous transhepatic biliary drainage (PTBD) was performed. Post-PTBD cytological examination of bile was negative for cancer. A third biopsy showed slight hyperplasia with no malignant findings. Recholangiography, performed through PTBD, suggested gradual improvement of bile duct stricture, but could not completely exclude the possibility of malignancy; thus, resection of the bile duct including the stricture site was performed, and the resected specimen was submitted for intraoperative frozen section examination. Histopathological diagnosis did not reveal malignant findings. After cholecystectomy and bile duct resection, hepaticojejunostomy (Roux-en-Y) was performed. Because only erosion and desquamation of the mucosal epithelium and mild submucosal inflammatory cell infiltration and fibrosis were observed, chronic cholangitis was diagnosed histopathologically. Surgical resection of the bile duct should be considered for potentially malignant stricture of the bile duct.     

肝内胆管结石并胆管狭窄的外科治疗

肝内胆管结石并胆管狭窄由于结石易残留和复发 ,手术疗效不甚满意 ,且并发症多 ,是临床难题之一。我院自 1 991年 1月至 1 999年 1 2月 ,应用肝叶、肝段切除联合肝胆管空肠大口吻合治疗本病共 41收稿日期 :2 0 0 0 -0 4-17作者简介 :李祥 (196 6 -) ,男 ,湖北宜昌人 ,主治医师。例 ,取得较好疗效 ,现报道如下。1　临床资料1 .1　一般资料　本组男 1 9例 ,女 2 2例 ,年龄 2 5～63岁 ,平均 45岁。病史 8个月～ 2 2年 ,平均 1 2年。主要症状为右上腹痛、寒战、发热、呕吐、巩膜黄染。B超检查 :36例为肝内胆管结石 ,5例为胆总管结石。一次手术 …     

损伤性胆管狭窄的外科治疗

目的 评价损伤性胆管狭窄的外科治疗效果。方法 总结了近8年来收治的56例医源性胆管狭窄病例，其中男性26例，女性30例。行开腹胆囊切除术致伤者36例，占64.29％．腹腔镜胆囊切除术损伤4例，胆总管探查术损伤14例。损伤后距来我院的时间以半年至2年为最多。治疗多已属后期，且胆管狭窄部位高。56例病人在我院进行了胆肠通路的重建手术或胆管狭窄的修复手术。结果 随访率(51／56)为91．07％．50例随访时间超过2年。3例因狭窄复发再次手术。疗效，优良率为90％。本组无手术死亡。结论 研究表明Roux-en-Y胆肠吻合术是治疗胆管狭窄尤其部位较高。狭窄段较长的胆管狭窄的有效方法。利用带蒂胆囊瓣。空肠瓣和胃壁瓣修复胆管也取得了良好疗效。同时进行胆管内支撑有助于提高疗效，防止胆管再狭窄。     

一种治疗良性高位胆管狭窄的新手术方式

良性高位胆管狭窄临床上屡见不鲜 ,常由于肝胆管结石、胆管炎或医源性胆管损伤后所致。本病的治疗颇为棘手 ,特别是后者 ,病人常有多次胆道手术史 ,肝门粘连严重 ,病变位置高而深 ,术时找寻狭窄的肝门胆管颇感费力 ,且易损伤十二指肠球部 ,增加术后的危险。为此 ,我们设计了一种新的手术方式 :肝门胆管十二指肠端端大口吻合、十二指肠球部与十二指肠三段端侧同步吻合术。曾施行多例 ,其中随访超过 1 5年以上者 3例 ,情况良好 ,无再发生胆道狭窄、重症胆管炎、胆石等症状 ,疗效满意 ,现介绍该手术方法。所有选用本手术治疗的病人 ,术前均经 …     

损伤性肝外胆管狭窄的外科治疗

目的:探讨损伤性肝外胆管狭窄外科治疗的效果 。方法:回顾分析25例损伤性肝外胆管狭窄的临床资料 。结果:全组25例中,高位狭窄13例,中段狭窄11例,下段狭窄1例。有22例施行肝胆肠空肠Roux-Y吻合术,2例施行肝胆管十二指肠间置空肠吻合术,仅1例施行胆总管十二指肠侧侧吻合术。有3例发生短暂性吻合口胆瘘,经负压吸引治愈。无死亡率。全组均随访1年,10例随访5年以上,效果良好 。结论:在胆管急性炎症控制后一个月内尽早手术为妥,手术方式以肝胆管空肠Roux-Y吻合术为佳。     

复杂型胆管狭窄及其外科治疗

目的 探讨复杂型胆管狭窄外科治疗方法与手术适应证选择。方法 总结分析了1984年6月到2001年5月期间治疗的复杂型胆管狭窄357例。结果 术后死亡9例，手术死亡串2．5％。治愈出院的348例获l—12年随访，随访串80．7％。其中217例获6-12年随访，长期随访串62．4％。随访中14例死亡，总死亡串6．4％。随访优良串83．3％。结论 复杂型胆管狭窄是外科治疗中的难题，只有根据病人的不同情况来选择多种不同方法的联合手术，方可获满意效果。     

Long-term follow-up after bilioenteric anastomosis for benign bile duct stricture.

OBJECTIVE: The authors provide a prospective evaluation of long-term results after bilioenteric anastomoses for benign biliary stricture. SUMMARY BACKGROUND DATA: With the advent of laparoscopic techniques, the frequency of bile duct injury after operation has increased. Reports on the operative management of these injuries have not provided long-term follow-up. Over a similar period, reports of both endoscopic and invasive radiographic methods as primary treatment for bile duct stricture have compared success rates to antiquated surgical reports. METHODS: A protocol whereby preoperative radiographic (e.g., cholangiogram, computed tomographic scan, ultrasound), biochemical (e.g., alkaline phosphatase, and total bilirubin), and clinical evaluation was combined with ongoing postoperative evaluation and follow-up at approximately 6-month intervals. A total of 111 patients were evaluated from 1985 to 1995. Patients were categorized in three groups: 1) those with postoperative injuries during open and laparoscopic gallbladder surgery (31 patients), 2) those undergoing operation for pain associated with chronic pancreatitis who have distal common bile duct stenoses (64 patients), and 3) those with nonchronic pancreatitis-associated benign bile duct strictures (16 patients). RESULTS: Mean follow-up was 60 months. Overall preoperative alkaline phosphatase was 640 units/L with a range of 280 to 1860 units/L. All patients had abnormally elevated alkaline phosphatase. Only 3 of 111 patients have had mild persistent elevation after operation. Clinical jaundice, present in 49 of 111 patients, was resolved uniformly by operative decompression. Total bilirubin was elevated abnormally in 56 of 111 patients and also was uniformly corrected by operation. CONCLUSIONS: These data support the careful combined use of endoscopy, invasive radiology, and surgery in the management of benign strictures of the biliary tree. These data further suggest a success rate for surgical management that, over long-term follow-up, appears to exceed that found using alternative measures. Alternative methods should measure their success rates against success rates currently achieved by operative management.     

损伤性高位良性胆管狭窄的外科治疗策略

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term surviv...     

肝内胆管结石并肝胆管狭窄的外科治疗

报道外科手术治疗肝内胆管结石３０１例．其中合并胆管狭窄１８４例．占６１．１３％。诊断靠ＰＴＣ、ＥＲＣＰ、ＢＵＳ、ＣＴ，术中胆道造影及术后经Ｔ管或Ｕ管造影。采用狭窄段胆管整形、胆肠吻合、肝部分切除术、高位胆管扩张后Ｕ管支撑等术式治疗。住院病死率为２．６６％。术后随访１～２０年，随访率为９４．２０％。随访结果属优者占７４．６４％；良者占２４．２７％；死亡３例（占１．０９％）；死亡原因为感染性休克。     

Palliative treatment with metallic stents for unresectable gallbladder carcinoma involving the portal vein and bile duct

We report a case of gallbladder carcinoma associated with biliary obstruction and portal vein stenosis caused by massive lymph node metastases. The patient, a 59-year-old woman, was treated with self-expandable metallic stents — a spiral Z-stent in the portal vein, and a Wallstent in the bile duct — and intra-arterial infusion chemotherapy. She returned to work immediately after leaving the hospital, and has been treated with intra-arterial infusion chemotherapy once a week at our outpatient department. At present, she has good quality of life, with patency of both endoprostheses, 8 months after the placement of the metallic stents in the portal vein and the common bile duct. This case shows that portal vein and biliary stenting, together with intra-arterial infusion chemotherapy, can be an effective modality for the palliative treatment of advanced gallbladder carcinoma involving the portal vein and bile duct, to improve quality of life. Received for publication on Dec. 4, 1999; accepted on Feb. 14, 2000     

损伤性肝外胆管狭窄的诊断和治疗

目的探讨损伤性肝外胆管狭窄的诊断方法和治疗效果。方法回顾性分析2000-2009年间损伤性肝外胆管狭窄21例的临床资料。结果 B超、CT、MRCP和ERCP是确诊肝外胆管狭窄常用的诊断方法。高位狭窄12例,其中6例为修复后再狭窄;低位狭窄9例。16例施行肝胆管-空肠Roux-Y吻合术,3例施行肝胆管-十二指肠间置空肠吻合术,2例施行胆总管-十二指肠侧侧吻合术。1例术后发生吻合口胆漏,经持续低负压吸引治愈。无死亡病例。全组均随访1年以上,其中10例已5年以上,均效果良好(95.23%)。结论肝外胆管狭窄一经诊断明确,即应考虑手术治疗;若胆管有急性炎症,应在炎症得到控制1个月后尽早手术为妥;肝胆管-空肠Roux-Y吻合是最常用的手术。