肝十二指肠韧带减张术在医源性胆管缺损中的临床应用研究

目的 探讨胆管缺损较大的医源性胆管损伤病例采用肝十二指肠韧带减张术（简称减张术）的可行性和有效性。方法 笔者于2006年3月至2009年5月共收治胆管缺损较大的医源性胆管损伤患者6例，其中BismuthⅡ型5例，BismuthⅢ型1例。采用7号丝线缝合肝门板组织与十二指肠球部浆肌层并打结，将肝门部与十二指肠球部拉拢的方法，借以缩短肝十二指肠韧带，使缺损胆管两断端真正在无张力下行端端吻合术。结果 6例胆管损伤患者，经肝十二指肠韧带减张术均获痊愈，随访至今未见有并发症。结论肝十二指肠韧带减张术对胆管缺损较大的医源性胆管损伤的治疗效果确切，可作为一种新的理念和术式在临床上推广应用。

The use of the hepatoduodenal ligament tension-reduced operation in iatrogenic bile duct injury

Objective To investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. Methods Between March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. Results Six patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. Conclusions The tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.