CAJ | 학술논문

目的探讨医源性胆管损伤导致远期胆管狭窄及闭锁并发症的治疗方法及要点.方法回顾性分析2002年6月至2006年7月收治的5例因胆囊切除手术时胆管损伤导致胆管狭窄及闭锁远期并发症患者的临床资料.结果 5例医源性胆管损伤远期并发症包括:肝总管完全闭锁2例,肝门部胆管狭窄2例,胆肠吻合口狭窄1例.其中,2例为腹腔镜胆囊切除手术,3例为小切口胆囊切除术.损伤部位按Strasberg分型包括:E1型、E2型、E3型各1例、E5型2例.5例胆管损伤远期并发症患者,均于经皮肝胆管穿刺造影及引流减黄治疗后进行手术探查及胆道重建.手术方法包括肝门部肝管成型、肝管空肠Roux-en-Y吻合术3例,肝总管空肠Roux-en-Y吻合术2例,术后均恢复良好出院.5例患者均随访7年以上,未再发生梗阻性黄疸及胆道感染,目前仍在随访中.结论对医源性胆管损伤导致胆管狭窄及胆管闭锁远期并发症患者,应先施行经皮肝胆管穿刺造影及引流治疗,待黄疸及炎症控制后二期手术行胆管空肠Roux-en-Y吻合.耐心细致解剖肝门、将损伤近端正常胆管组织与空肠吻合及保证吻合口足够大是手术治疗成功的要点.
목적 탐토의원성담관손상도치원기담관협착급폐쇄병발증적치료방법급요점.방법 회고성분석2002년6월지2006년7월수치적5례인담낭절제수술시담관손상도치담관협착급폐쇄원기병발증환자적림상자료.결과 5례의원성담관손상원기병발증포괄:간총관완전폐쇄2례,간문부담관협착2례,담장문합구협착1례.기중,2례위복강경담낭절제수술,3례위소절구담낭절제술.손상부위안Strasberg분형포괄:E1형、E2형、E3형각1례、E5형2례.5례담관손상원기병발증환자,균우경피간담관천자조영급인류감황치료후진행수술탐사급담도중건.수술방법포괄간문부간관성형、간관공장Roux-en-Y문합술3례,간총관공장Roux-en-Y문합술2례,술후균회복량호출원.5례환자균수방7년이상,미재발생경조성황달급담도감염,목전잉재수방중.결론 대의원성담관손상도치담관협착급담관폐쇄원기병발증환자,응선시행경피간담관천자조영급인류치료,대황달급염증공제후이기수술행담관공장Roux-en-Y문합.내심세치해부간문、장손상근단정상담관조직여공장문합급보증문합구족구대시수술치료성공적요점.
Objective To evaluate the therapeutic methods and the key points in the management of delayed complications of bile duct stenosis after iatrogenic bile duct injuries.Methods Five patients with bile duct injuries developed delayed complications of bile duct stenosis after cholecystectomy were retrospectively studied.All clinical information were derived from the medical data of these 5 patients treated in our department from June 2002 to July 2006.Results Of the 5 patients with delayed complications of iatrogenic bile duct injuries,2 patients developed common bile duct occlusion,2 patients developed hilar bile duct stenosis,and 1 patient developed anastomotic stenosis after cholangiojejunostomy.Bile duct injuries occurred in 3 patients after laparoscopic cholecystectomy,and in another 2 patients after mini-laparotomy-cholecystectomy.The locations of the bile duct injuries,according to Strasberg classification,were type E1 (n=1),type E2 (n=1),type E3,(n=1),and type E5 (n=2).All 5 patients received PTCD initially to relieve obstructive jaundice and then they received surgical exploration and biliary reconstruction.These patients received cholangioplasty at the porta hepatis,and hepaticojejunostomy using a Roux-en-Y anastomosis.Two patients received Roux-en-Y anastomosis of the common hepatic duct to the jejunum.All these patients had good recovery and were discharged well postoperatively.All patients had been followed-up for 7 years or more,with no evidence of obstructive jaundice or biliary tract infection.Conclusions For patients who present with delayed complications of bile duct stenosis after iatrogenic bile duct injuries,primary PTCD is carried out to relieve jaundice and to control infection.Meticulous dissection of the porta hepatis,reliable anastomosis of the proximal healthy bile duct tissues to a jejunal loop,and adequate size of anastomosis guarantee success of surgery.