胆道损伤行胆肠Roux-en-Y吻合后胆道再次狭窄的处理

目的探讨胆道损伤经胆肠Roux-en-Y吻合后胆道再次发生狭窄的手术时机和方法。方法回顾性分析2005年11月至2006年10月间,上海交通大学医学院附属瑞金医院外科收治的胆道损伤经胆肠Roux-en-Y吻合后发生再次狭窄的7例临床资料。结果胆道损伤均由胆囊切除所造成,其中6例为腹腔镜胆囊切除术,1例为小切口胆囊切除术。发生胆道损伤的类型,按Strasberg分型:E11例、E23例、E32例和E41例。6例接受了再次高位胆肠Roux-en-Y吻合,其中1例施行了二期右半肝切除术,另1例施行了胆道外引流术,所有病人恢复基本良好。结论胆肠Roux-en-Y吻合是修复胆道损伤的主要治疗方法,尤其对于再次胆肠Roux-en-Y吻合的病例,手术时机和手术方式的合理选择、手术技术的精益求精是成功的关键。

Surgical experience on biliary re-stricture after Roux-en-Y hepaticojejunostomy for bile duct injury

Objective To discuss the operation timing and methods of biliary re-stricture after Roux-en-Y hepaticojejunostomy for bile duct injury.Methods From November 2005 to October 2006,seven cases of biliary re-stricture after Roux-en-Y hepaticojejunostomy for bile duct injury were admitted into Department.of Surgery,Ruijin Hospital,Medical School of Jiaotong University.The clinical data were analyzed retrospectively.Results All these bile duct injuries were caused by cholecystectomy,six cases were laparoscopic cholecystectomy and one case was mini-incision choleystectomy.According to the classification of Strasberg,one case was E1,three cases were E2,two cases were E3 and one case was E4.Six patients were performed Roux-en-Y hepaticojejunostomy again,and one of them received right hepatectomy afterward,and the remaining one patient received external biliary drainage.All these patients recovered fairly well.Conclusion Roux-en-Y hepaticojejunostomy is still the main approach for bile duct injury repairment.For those complicated cases,the optimal timing and method of operation,the meticulous and excellent surgical skills are keys to success.