带蒂脐静脉瓣胆道修复术与远期疗效

目的　总结带蒂脐静脉瓣胆道重建的临床经验和远期随访结果。方法　第一种术式 ,胆管上下端后壁对端吻合 ,前壁纵行切开 ,其缺损以带蒂脐静脉瓣修复 2 2例 ;第二种术式 ,胆管狭窄切开、整形 ,胆管缺损以带蒂脐静脉瓣修复 19例。结果　本组无死亡病例 ,术后达 7年以上 2 5例 ,其中再手术 3例 ,术后 7- 12年ERCP 10例 ,MRCP和双剂量静脉胆道造影各 1例 ,胆道显影均正常 ;轻度胆管炎 2例 ;另 8例无任何胆道感染症状 ,B超胆道未见异常。结论　带蒂脐静脉瓣胆道重建是一种理想的胆道修复手术。

Bile duct reconstruction with pedicled umbilical vein graft

Objective To sum up the clinical experiences and long-term follow-up outcomes of bile duct reconstruction with pedicled umbilical vein graft. Methods Two surgical techniques were used: (1) End-to-end anastomosis was performed initially between the posterior walls of the bile ducts, and the anterior walls incised longitudinally. Then the defects of bile duct wall was repaired by pedicled umbilical vein graft. Twenty-two patients underwent this reconstructiory; (2) Incision and reconstructing strictures of the biliary tract, thereafter, the defects was replaced by the pedicled umbilical vein graft. This operation was performed in 19 patients. Results There was no peri-operative death. 25 patients had survived over 7-year, only 3 cases were reoperated on. Normal bile tracts were demonstrated by using ERCP in 10 cases, MRCP in 1 case and venous cholangiography in 1 case. 2 patients had slight symptoms of cholangitis, no abnormal symptoms and ultrasonic findings were present in other 8 cases. Conclusions Bile duct reconstruction with pedicled umbilical vein graft is a ideal procedure for repairing the defects of bile duct.