Clinical features and surgical repair of posthepatectomy bile duct strictures
10.3760/cma.j.issn.1007-8118.2018.08.007
- VernacularTitle:肝切除术后损伤性胆管狭窄的临床特征与手术修复
- Author:
Jianping ZENG
1
;
Zhe LIU
;
Liang WANG
;
Xuedong WANG
;
Shuo JIN
;
Dongdong HAN
;
Jiahong DONG
Author Information
1. 102218,清华大学附属北京清华长庚医院肝胆胰中心
- Keywords:
Hepatectomy;
Bile duct injuries;
Bile duct stricture;
Hepaticojejunostomy
- From:
Chinese Journal of Hepatobiliary Surgery
2018;24(8):526-529
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical features and definitive repair strategies of bile duct strictures after hepatectomy.Methods The clinical data of patients undergoing definite repair for bile duct strictures after hepatectomy in the PLA General Hospital from 2000 to 2014 and Beijing Tsinghua Changgung Hospital from 2014 to 2017 were retrospectively collected.Results Twenty-one patients with bile duct stricture after hepatectomy were treated with reoperation.Among them,13 cases showed continuous bile leakage after operation.The types of hepatectomy include 10 cases of left or extended left hemihepatectomy,7 cases of right or extended right hemihepatectomy,2 cases of mesohepatectomy,and 2 cases of hepatic caudate labectomy.According to classification formulated by the Biliary Surgery Group of Chinese Medical Association,the types of injuries of the patients included four of Ⅱ 2,twelve of Ⅱ 3,and five of Ⅱ 4 respectively.19 of 21 patients underwent definitive repair with hepaticojejunostomy.The long-term follow-up success rate was 89.0％.Conclusions Biliary injury after hepatectomy in which the injury affects the secondary or below hepatic ducts requires surgical repair.Hepaticjejunostomy is an effective definitive repair method.Hepaticjejunostomy for bile duct stenosis after right hemihepatectomy always need to dissect the left intrahepatic bile duct by a hilar plate approach or UPV approach,due to the effect of hepatic portal transposition.Surgical repair for bile duct stenosis after the left hepatectomy,always need the incision of the right anterior and right posterior hepatic duct,due to extensive injuries of hepatic duct.
