摘要
胆管损伤(BDI)是胆囊切除术后常见的严重并发症。BDI首次手术修复后胆道再狭窄的原因是多方面的,影响因素主要包括:BDI的类型、手术修复的时机、手术修复的方法、合并肝动脉损伤和术者经验。BDI首次手术后胆道再狭窄的治疗十分棘手,手术难度大。术前详细的影像学特别是胆道树的直接影像检查评估对手术方案的选择十分重要。具体的治疗措施视病人的全身状况、肝功能及其储备功能、胆管狭窄的部位和有无合并肝内胆管结石、胆汁性肝硬化等因素而定。胆道金属支架植入术只适用于高龄、不能耐受手术或预测生存期不超过2年的病人。狭窄段胆管切除、肝门部胆管空肠Roux-en-Y吻合术是最常用的手术方式,效果良好。对左、右肝管或以上胆管狭窄合并肝内胆管结石或肝叶萎缩,健侧肝无肝硬化、肝功能良好的病人,应行肝切除术。
Abstract Iatrogenic bile duct injury （IBDI） is a severe complication of cholecystectomy. The major factors related to re-stenosis of bile duct after initial surgical repair includes type of IBDI, timing of initial surgical repair, initial surgical procedures, being accompanied by hepatic arterial injury and performed operation. The treatment for re-stenosis of bile duct is difficuh. Preoperat imaging studies especially the cholangiogram of the whole biliary tree are critical important Ibr surgical planning. The treatment modality adopted should comprehensively depend on the general condition of patient, liver function and liver function reserve, the site of biliary stricture, with or without intrahepatic stones and biliary cirrhosis. Metal stent placement is only indicated for patients who are intolerance of operation, or whose life expectancy are less than 2 years. Removal of the biliary stricture and hilar hile duct-jejunum Ronx-en-Y anastomosis is the common used procedure for re-stenosis of bile duct after initial surgical repair for IBDI, and the long-term outcome is a satisfactory. For those with right or left hepatic duct stricture accompanied by intrahepatic stone or affected side liver atrophy, and with a good Diver function, and without liver cirrhosis at the contralateral side, liver resection is indicated.
出处
《中国实用外科杂志》
CSCD
北大核心
2011年第7期578-580,共3页
Chinese Journal of Practical Surgery
关键词
胆管损伤
狭窄
再手术
bile duct injury
stricture
reoperation
