胆囊切除术后良性胆管狭窄合并门静脉高压患者的管理
Management of patients of postcholecystectomy benign biliary stricture complicated by portal hypertension.
作者信息
Agarwal Anil K, Gupta Vishal, Singh Shivendra, Agarwal Shaleen, Sakhuja Puja
机构信息
Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India.
出版信息
Am J Surg. 2008 Apr;195(4):421-6. doi: 10.1016/j.amjsurg.2007.03.013.
BACKGROUND
Portal hypertension (PHT) is seen in 15% to 20% of patients with postcholecystectomy benign biliary stricture (BBS). Preliminary portosystemic shunt (PSS) has been recommended to reduce the morbidity and mortality associated with direct stricture repair. Single-center experience of primary repair without preceding PSS in patients of BBS with PHT and a patent portal vein is presented.
METHODS
A retrospective study of 13 patients with postcholecystectomy BBS with PHT managed between January 1, 2000 and March 31, 2006.
RESULTS
Roux-en-Y hepaticojejunostomy was performed in 11 patients. There was no major morbidity or mortality with minor complications seen in 3 patients. The median duration of surgery was 3.5 hours with a median blood loss of 300 mL. All patients were asymptomatic at a median follow-up of 17 months.
CONCLUSION
Hepaticojejunostomy can be performed safely without prior portal decompression in patients with postcholecystectomy BBS complicated by PHT but with a patent portal vein.
背景
在胆囊切除术后良性胆管狭窄（BBS）患者中，15%至20%会出现门静脉高压（PHT）。有人建议进行初步门体分流术（PSS）以降低与直接狭窄修复相关的发病率和死亡率。本文介绍了在患有PHT且门静脉通畅的BBS患者中，未经先行PSS进行一期修复的单中心经验。
方法
对2000年1月1日至2006年3月31日期间接受治疗的13例胆囊切除术后BBS合并PHT患者进行回顾性研究。
结果
11例患者接受了 Roux-en-Y 肝空肠吻合术。无重大发病率或死亡率，3例患者出现轻微并发症。手术中位时长为3.5小时，中位失血量为300毫升。所有患者在中位随访17个月时均无症状。
结论
对于合并PHT但门静脉通畅的胆囊切除术后BBS患者，可不先行门静脉减压而安全地进行肝空肠吻合术。
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