CAJ | 학술논문

目的前瞻性地评价肝门胆管良性狭窄的处理方式与近远期疗效的关系。方法前瞻性地观察了按病因不同分为4组的25例患者，分别以不同方式治疗所取得的近远期疗效。结果肝门胆管空肠吻合术治疗良性医源性肝门胆管狭窄疗效确切，随访期间返流性胆管炎1例，发生率较低，仅为10%；肝门胆管原位整形保持了胆管生理学的完整性，惟需可用的良好的自体修补组织及合理的手术设计两个因素；含石的萎缩右半肝切除加肝门胆管整形既达到了清除病灶的目的，又保持了胆管的通畅性及生理功能的完整性；气囊扩张虽对轻度环形狭窄有良效，但继发性硬化性胆管炎伴肝门管状狭窄气囊扩张疗效欠佳。结论根据不同病因选择各异的治疗方案(个体化)，处理肝门胆管良性狭窄可获近远期良效。
목적 전첨성지평개간문담관량성협착적처리방식여근원기료효적관계。방법 전첨성지관찰료안병인불동분위4조적25례환자，분별이불동방식치료소취득적근원기료효。결과 간문담관공장문합술치료량성의원성간문담관협착료효학절，수방기간반류성담관염1례，발생솔교저，부위10%；간문담관원위정형보지료담관생이학적완정성，유수가용적량호적자체수보조직급합리적수술설계량개인소；함석적위축우반간절제가간문담관정형기체도료청제병조적목적，우보지료담관적통창성급생리공능적완정성；기낭확장수대경도배형협착유량효，단계발성경화성담관염반간문관상협착기낭확장료효흠가。결론 근거불동병인선택각이적치료방안(개체화)，처리간문담관량성협착가획근원기량효。
Objective To evaluate the linkage between the proxmal as well aslong term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis. Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.