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医源性胆管损伤后胆管狭窄并发肝胆管结石的治疗的初步研究
Preliminary study of the treatment on hepatolithus complicating biliary stricture after iatrogenic injury

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DOI:
作者:
骆助林，田伏洲 ，汤礼军 ，汪涛， 戴睿武 ，任建东
Luo Zhulin, Tian Fuzhou, Tang Lijun, Wang Tao
作者单位:
成都军区总医院全军普通外科中心
The Department of General Surgery , Chengdu Military Command General Hospital
关键词:
医源性胆管损伤，肝胆管结石，胆道狭窄，胆道球囊扩张器
Iatrogenic biliary injury; Hepatolithus; Biliary stricture; Balloon dilatation
摘要:
[摘要] 目的 总结8年来我院治疗医源性胆管损伤后胆管狭窄并发肝胆管结石的初步经验。方法 2001年1月至2009年1月间，共收治130例医源性胆管损伤后胆管狭窄患者，其中31例损伤后胆管狭窄并发肝胆管结石，平均年龄为49岁(28~64岁)；男22例，女9例，所有病例按Bismuth分型，I 型9例，II型7例，III型4例，IV型10例，V型1例。I 型、II型胆管狭窄采用切除狭窄胆管，术中胆道镜取石并胆管空肠吻合手术，III型、IV型、V型采用切开狭窄部，视情况切除部分肝脏，胆道镜取石后行肝管空肠吻合术，术中于吻合口内放置扩张球囊，术后定期球囊渐进性扩张并随访观察。结果 31例患者均完成手术，术后随访6个月—5年，平均2.8年，31例患者术后均未出现腹痛、发热、黄疸、皮肤搔痒等胆管炎及胆管狭窄症状，B超、胆道镜、MRCP检查吻合口无狭窄。结论 针对不同病情的医源性胆管损伤后胆管狭窄并发肝胆管结石，采用不同的治疗方法可以取得满意的治疗效果。
ABSTRACT Objective: To summarize the treatment experiences of the patients suffered the hepatolithus complicating biliary stricture after iatrogenic injury in our hospital in the recent 8 years. Methods: In our hospital, there were 130 patients with iatrogenic biliary tract injury between Jan 2001 and Jan 2009, and 31 of them (male 22, female 9), of mean age 49 (range 28~64) years, with complicated hepatic calculus, were grouped according to Bismuth categories: type I, 9; type II, 7; type III , 4; type IV, 10; type V, 1. Patients with type I and II biliary stricture underwent resection of stenotic parts with subsequent calculus removal by choledochoscope followed by cholangio-jejunostomy. The discission in the stenotic parts was preferentially carried out followed by partial hepatectomy in the other patients. Subsequently the hepatojejunostomy was then performaced after the stones were removed by choledochoscope. In the precedure of hepatojejunostomy, the balloons were placed in the anastomotic stoma and were progressive dilated regularly after the operation. Results: After the follow-up of mean 2.8 (range 0.5~7) years, no stricture in the anastomotic stoma was found in all 31 patients, according to the examinations of B-mode ultrasonography, choledochoscope and magnetic resonance cholangiopancreatography (MRCP), with no symptoms correlated with cholangeitis and biliary stricture like abdominal pain, fever and choloplania et al. Conclusion: The patients with hepatolithus complicating biliary stricture after iatrogenic injury can be efficiently treated when appropriate therapeutic methods were taken according to different states of the illness.

 

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