高位胆管良性狭窄的原因和治疗

目的探讨高位胆管良性狭窄的原因和防治。方法回顾性总结分析高位胆管良性狭窄460例的病因和治疗方法。结果病因依次为肝胆管结石(383例)、高位胆管损伤(54例)、胆囊结石Mirizzi综合征(21例)、单纯良性狭窄(2例)。分别行肝叶或肝段切除；经肝剖开狭窄胆管，肝胆管或肝门胆管空肠吻合；肝门胆管狭窄切开整形后与空肠大口吻合；吻合口狭窄切开扩大吻合；肝门胆管狭窄切开整形后T管支撑等手术。效果满意，优良率为90．1％。结论高位胆管良性狭窄的主要原因是肝胆管结石(83．3％)和高位胆管损伤(11．7％)。肝叶或肝段切除，或联合肝内胆管或肝门胆管空肠大口吻合是治疗肝胆管结石并肝胆管狭窄的有效方法。高位胆管损伤初期修复后较易发生胆管或吻合口狭窄，再次修复以胆管空肠Roux-en-Y大口吻合术效果最好。强调重在预防，在行胆道手术时避免胆管损伤。     

医源性胆管损伤合并高位胆管狭窄的外科治疗

目的 探讨知源性胆管损伤合并高位胆管狭窄的外科治疗。方法 对1996－1999年间治疗12例胆管损伤合并高位胆管狭窄采用肝胆管大口式、空肠Roux-y吻合术。结果 12例患者均行随访,疗效满意。结论 采用肝胆管大口式、空肠Roux-y吻合术是治疗胆管损伤合并高位胆管狭窄的有效方法。     

医源性损伤性胆管狭窄的外科治疗

Iatrogenic traumatic biliary stricture is one of the difficult points in the biliary surgery,and operation is the only definitive treatment. The operative opportunity,surgical procedure and techniques ...     

医源性胆管损伤伴狭窄的手术治疗

目的:探讨肝管空肠吻合术治疗医源性胆管损伤伴狭窄的效果及注意事项。方法:回顾分析17例医源性胆管损伤患者的临床资料,着重分析了手术前准备、手术操作方法及影响手术效果的各项因素。结果:17例患者均为胆囊切除术时损伤胆管,其中5例为开腹胆囊切除,12例为腹腔镜胆囊切除。损伤分型:Ⅱ型5例,Ⅲ型8例,Ⅳ型3例,Ⅴ型1例。修复手术(肝管空肠吻合术)时间离前次胆囊手术最短者为4个月,最长者为6年。术后经2个月至5年随访,患者情况良好。结论:在行决定性手术前,患者全身及局部条件必须得到满意改善,清晰全面的胆管造影片必不可少,术中正确操作,肝管空肠吻合术治疗医源性胆管狭窄可获得满意疗效。     

高位胆管良性狭窄的外科治疗

高位胆管良性狭窄是胆道外科复杂而棘手的难题,外科手术是唯一有效的治疗方法,由于狭窄位置高、胆管变异、周围粘连使外科处理尤为困难,并且术后再狭窄发生率高.我院2001年1月至2007年12月收治41例,报道如下.     

复杂损伤性胆管狭窄的治疗

Biliary stricture after cholecystectomy poses difficult management problems to surgeons because of high and stable incidence.In contrast to malignant stricture,benign stricture requires durable repair....     

高位胆管良性狭窄外科治疗探讨

高位胆管良性狭窄是指胆囊管汇入胆总管以上的肝胆管因结石、炎症、损伤及先天性因素所致的胆管狭窄,是胆道外科复杂的病变与并发症,常导致肝实质损害、胆汁性肝硬变,治疗极为棘手。鉴于此,现将我院2001年1月～2006年1月收治的33例高位胆管良性狭窄患者的手术治疗作一分析,探讨有效的手术方式,减少再手术率。     

医源性胆管损伤性狭窄术式选择——胆管直接吻合?胆管空肠吻合?

医源性胆管损伤性狭窄是胆管损伤后最常见的并发症。其治疗的目的是恢复或重建胆管的通畅性和功能[1]。胆管损伤性狭窄的手术修复方法主要有胆管对端吻合、利用自体带蒂组织瓣修复和胆肠吻合术,前两种手术方法保     

高位胆管损伤性狭窄的外科处理

由于外伤、医疗相关操作或其他任何原因破坏了胆道系统的完整性和通畅性,即为胆管损伤.当这种损伤发生在左、右肝管汇合部或以上引起胆管狭窄,称为高位胆管损伤性狭窄.由于其位置深、解剖复杂,且常由于经历过手术治疗,局部粘连严重,外科处理时需要一定的技术和经验.     

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 …     

肝管空肠吻合术治疗医源性胆管损伤伴狭窄

医源性胆管损伤是胆囊切除术严重的并发症之一.在LC迅速发展的今天,LC导致医源性胆管损伤的发生率较开腹胆囊切除术更高.2006年10月至2011年8月我中心采用肝管空肠吻合术治疗14例医源性胆管损伤患者,取得了良好的疗效,现报道如下. 1 资料与方法 1.1 一般资料 本组医源性胆管损伤患者14例,男6例,女8例;年龄28～62岁,平均年龄46岁.5例胆管损伤发生于开腹胆囊切除术,9例发生于LC.14例患者中,修复手术距胆囊切除术时间4个月至6年.4例患者带有T管.所有患者有急、慢性胆管炎表现,包括腹痛,伴或不伴发热,症状发作时均伴有黄疸.     

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。     

胆管损伤修复术后胆管狭窄的处理

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。　结论　胆管损伤修复术后胆管狭窄再次行手术治疗可获满意效果     

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.     

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.     

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.     

Recurrent bile duct stricture: causes and long-term results of surgical management

Background/Purpose The management of recurrent bile duct strictures is a challenge for surgeons. This study reports the experience of revision surgery in patients referred following the failure of primary repair, and compares the outcome with that in patients who underwent management of recurrent stricture following primary repair at our institution. Methods Over a period of 15 years, 300 patients with postcholecystectomy benign biliary stricture underwent surgical repair at our institution; 36 patients (12%) were referred after a failed primary repair. Results In 25 (69%) patients, the primary repairs were done at peripheral hospitals. Twelve (33%) had had an early repair, at the time of cholecystectomy while 24 (67%) had a delayed repair at a later date; 83% and 67% of the patients who had undergone early and delayed repair, respectively, had not had a preoperative cholangiogram. Primary repairs performed were a bilioenteric anastomosis (22; 61%) or an end-to-end bile duct repair (14; 39%). Twenty-seven (75%) patients presented within 90 days after the primary repair, and the median interval to recurrent symptoms was 45 days (range, 1 day to 6.1 years). The median delay in referral after the development of symptoms of restricture was 175 days (range, 30 days to 22 years). Twenty-three (64%) patients had high strictures (Bismuth types III-V). All patients underwent a Roux-en-Y hepaticojejunostomy. At a median follow-up of 37 months (range, 12–144 months), 33 of 35 evaluable patients (94%) with recurrent stricture had an excellent/good outcome compared to 223 of 242 evaluable patients (92%) who had had their primary repair at our institution. Ten (4%) patients had a poor result following primary repair at our center. There was a significant difference in the stricture repair-to-recurrence interval between those patients referred to us with recurrent strictures and those who failed after primary repair at our institution (median interval, 1.5 vs 20 months; P = 0.001) Conclusions Patients referred with recurrent strictures had had their primary repair at peripheral settings; the failures were technical, presenting early (median, 1.5 months) with recurrent symptoms, compared to findings in patients with recurrent strictures following primary repair at our center. The long-term outcome following the repair of the primary and the recurrent strictures was no different in our experience.     

医源性胆管损伤的紧急处理

目的探讨医源性胆管损伤的处理方法及注意事项。方法回顾性分析1992年10月至2005年1月西安地区会诊的13例医源性胆管损伤的术中处理方法，以及长期随访的疗效。13例中，男7例，女6例；腹腔镜胆囊切除（LC）9例，开腹胆囊切除（OC）4例。胆管横断伤5例，其中4例对端吻合术；另1例和3例胆管切除一段者，采用高位胆肠吻合术：胆管切除并左右肝管部切除5例，采用肝管Y形空肠“四针缝合法”吻合。结果随访5个月至13年，无手术死亡，无黄疸及胆道感染等并发症。结论胆管损伤一旦发生应及时处理．根据术中损伤类型，采取不同的处理方法。可获得满意的效果。     

自体组织修复肝门部胆管良性狭窄

目的 总结应用自体组织修复肝门部胆管良性狭窄的经验。方法 回顾分析我院自1989～2002年应用带蒂胆囊壁瓣修复肝门部胆管良性狭窄33例，应用肝圆韧带修复肝总管狭窄2例。结果 35例术后无明显胆瘘、出血等并发症，无手术死亡。术后T管造影显示无狭窄。术后30例(30/35)随访2个月至12年，仅有2例因术后胆管炎发作，经非手术治愈，收到良好效果。结论 应用自体组织带蒂胆囊壁瓣及肝圆韧带修复肝门部胆管良性狭窄符合生理性，取材方便，操作简便，效果良好。     

医源性晚期胆管狭窄的起因和处理

本组医源性晚期胆管狭窄的７６例病例中６３例,是胆囊切除或胆道探查手术损伤所致,其中曾行一次或多次胆管修复无效者３８例,隐性胆管损作远期发生狭窄１４例,胆道探查“Ｔ”管引流后期胆管狭窄１４例,胆道探查“Ｔ”管引流后期胆管狭窄１１例;因胆肠吻合术的适应证选择不当或吻合口狭窄１３例。胆管损伤的早期修复的关键是根据不同情况选择恰当的修复术式,缝合技术准确精细,吻合口宽大,无张力,避免胆漏和感染,晚期胆管狭