胆囊瓣修复肝外胆管良性病变缺损21例.docVIP

胆囊瓣修复肝外胆管良性病变缺损21例 作者：侯金华 高显清 龚兵 顾恒 黄峻松 余同辉 【摘要】 目的 总结 胆囊瓣修复肝外胆管良性病变缺损的经验。 方法 对21例肝外肝管良 性病变缺损行胆囊瓣修复，其中Mirizzi综合征型、型分别为7例和3例；胆囊、胆总管 瘘4例；肝门胆管炎性狭窄5例，胆总管阶段性狭窄2例。术后定期T形管造影和B超检查，并 对其进行回顾性总结。结果 全组均顺利完成手术，术后无漏胆汁，无明 显胆管炎出现，复查肝功能无异常改变。术后6个月T形管造影已显示胆管腔完整、内壁光滑 、无粘膜中断，十二指肠排放良好，但有4例有局限性扩张征象。6～12个月拔管，B超复查 效果满意。结论 胆囊瓣修复肝外胆管狭窄或缺损，术式操作简单，能保 持正常解剖结构，且保留了胆道的正常生理功能和Oddis括约肌功能等，是一种修复肝外 胆管良性病变缺损的有效方法。 【关键词】 胆囊瓣； 肝外胆管； 缺损； 手术 【Abstract】 Objective To study the experience of repairing benign lesion in extrahepatic bile duct with gallbladder flap. Methods 21 cases of patients with extrahepatic benign lesion were repaired with gallbladder flap. 7 cases and 3 cases were complicated with Mirizzi syndrome II and Ⅲ respectively,and 4 cases with cholecyst and choledochus fistula,5 cases with hepatic portal cholangitic stenosis, 2 cases with choledochus phasely steno sis. T tube visualization and B ultrasonic examination were performed regularly after surgery. And retrospective summary was performed to all of the patients. Results All the operations in this group were successfully comp leted, no leak bile and significant cholangitis occurred, and no abnormalities i n liver function. The result of T tube visualization after operation 6 months sh owed that the bile duct lumina was integrated, the intine smooth, and without mu cosa interruption, duodenum discharged fine. But 4 cases had limited dilated sig n. Extubated after 6 to 12 months, the results of rechecking with B ultrasonic w ere satisfying. Conclusion It is simple to repair the extrahepa tic bile duct stenosis or defection with gallbladder flap, and can maintain norm al anatomic structure, and reserves cholekinetic normal physiologic function of bile duct and function Oddi’s sphincter. It is an effective method to repair ben ign lesion of bile duct. 【Key words】 Gallbladder flap； Extrahepatic bile duct； Def ect； Operation 肝外胆管良性缺损或狭窄的 治疗 相对棘手，随着影像学的不断发 展，该部位病变的检出并不少见，我院1995年1月～2005年12月，采用带蒂胆囊瓣修复肝外 胆管良性病变缺损21例，取得良好效果。 1 临床资料 1.1 一般