医源性肝门部胆管损伤31例的外科处理

摘要

Objective To inquire the surgical treatment effect of the bile duct injuries around the hepatic portal. Methods The overall results of surgical treatment in 31 cases of bile duct injuries a-round the hepatic portal were retrospectively analyzed. The bile duct repair methods included bile duct-jejunostomy, end-to-end anastomosis of hepatic common bile, and duct bile duct sew and mend Results Among 31 cases of bile duct injury, 25 cases were found during operation, and 6 after operation. In 12 cases of Bismuth H type, 7 cases were subjected to bile duct-jejunostomy, 5 cases to end-to-end anastomosis of hepatic common bile duct, and 3 cases to bile duct sew and mend. In 9 cases of Bismuth m type, 7 cases were subjected to bile duct-jejunostomy, and 2 cases to end-to-end anastomosis of hepatic common bile duct. All 10 cases of Bismuth IV type were subjected to bile duct-jejunostomy. In one case of Bismuth H type, bile duct stricture occurred 3 months after the initial repair with end-to-end anastomosis of hepatic common bile duct, and bile duct-jejunostomy was done again 6 months later. In one case of Bismuth m type, bile duct stricture occurred 12 months after the initial repair with end-to-end anastomosis of hepatic common bile duct, and bile duct-jejunostomy was done. All 31 cases recovered well without bile duct stricture and bile duct inflammation during a follow-up period of 3 years from the last operation. Conclusion Primary repair is recommended for the bile duct injuries around the hepatic portal. The secondary bile duct injuries are repaired by bile duct-jejunostomy and the results are satisfactory. The surgical procedures and skills are the key for repairing the bile duct injuries around the hepatic portal.%目的 探讨医源性肝门部胆管损伤的外科处理效果.方法 回顾分析近10年来31例医源性肝门部胆管损伤外科处理总体效果.胆道修复手术分别为胆肠Roux-en-Y吻合术、胆管端端吻合术和胆管修补术.结果 31例肝门部胆管损伤,术中发现25例,术后发现6例.按Bismuth分型法并行胆道修复.其中Bismuth Ⅱ型12例,胆肠吻合7例,胆管端端吻合3例,胆管修补2例；Bismuth Ⅲ型9例,胆肠吻合7例,胆管端端吻合2例；Bismuth Ⅳ型10例,均行胆肠吻合术.Bismuth Ⅱ型有1例胆道修补术后3个月胆道狭窄,术后6个月改行胆肠吻合术；Bismuth Ⅲ型有1例胆管端端吻合术后12个月胆道狭窄,改行胆肠吻合术.术后随访1～3年,恢复良好,无胆管狭窄及胆管炎发作.结论 医源性肝门部胆管损伤应争取一期手术修复；继发性胆管损伤行胆肠Roux-en-Y吻合术效果良好.手术方法和细节决定了肝门部胆管损伤后胆道修复效果.