Surgical therapy of biliary restenosis after repair for bile duct injury in 16 cases
10.3760/cma.j.issn.1007-631X.2017.08.009
- VernacularTitle:胆管损伤修复术后狭窄再手术16例疗效分析
- Author:
Min HE
;
Jiayan YAN
;
Wei CHEN
;
Hui WANG
;
Jian WANG
- Keywords:
Bile ducts;
Wounds and injuries;
Postoperative complications
- From:
Chinese Journal of General Surgery
2017;32(8):665-669
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate remedy therapy for biliary restenosis after repair of bile duct injury.Methods Clinical data of 60 patients with bile duct injury including 16 patients with restenosis after repair admitted to Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2000 to December 2012 was retrospectively analyzed.Results 16 patients suffering from biliary duct restenosis included 3 cases of type Ⅱ 1 d,10 cases of type Ⅱ2 d,2 cases of type Ⅱ 3 d and 1 case of type Ⅱ 4 d.The reoperative procedures included hepatic hilar biliary plasty with bilioenteric anastomosis in 15 cases,right hemihepatectomy with left hepatic bilioenteric anastomosis in 1 case.Postoperative bile leakage in 3 cases and pleural effusion in 10 cases were cured by watchful therapy.All of the 16 cases were followed up with an average time of 5.2 years.No occurrence of cholangitis and elevated liver enzymes were observed up to now in 8 patients,increased γ-GT and ALP,no cholangitis but anastomotic stenosis as showed by MRCP in 6 patients with 2 patients neccesitating reoperation to address repeated cholangitis.Conclusions Restenosis after bile duct repair was closely associated with injury type,repair opportunity,repair methods and the surgeon's expertise.Precise preoperative evaluation,the choice of rational surgical approach,the clinging to mucosa-to-mucosa bilioenteric anastmosis principle and the establishment of postoperative long-term followup system centered on ALP,γ-GT and life quality score are required in the reoperation of stenosis after bile duct repair.
