Hwang Shin, Lee Sung-Gyu, Lee Young-Joo, Ahn Chul-Soo, Kim Ki-Hun, Moon Deok-Bog, Ha Tae-Yong
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2008 Oct;18(5):445-8; discussion 449. doi: 10.1097/SLE.0b013e31817a7e47.
Laparoscopic cholecystectomy (LC) has been accepted as a primary treatment modality for various benign gallbladder diseases. However, bile duct injury has occurred in a non-negligible proportion of patients who undergo LC. The outcome of primary reconstruction for LC-induced major bile duct injuries is usually favorable, but a small proportion of patients revealed serious biliary stricture during follow-up. We described the experience on the treatment for such delayed-onset bile duct strictures that occurred in 5 patients. One patient showed biliary strictures 6 months after primary hepaticojejunostomy, which were successfully treated with radiologic intervention. Other 4 patients underwent right lobectomy and redo hepaticojejunostomy 4 to 16 months after primary biliary reconstruction. No recurrent biliary stricture occurred during mean follow-up of 40 months. In conclusion, prolonged surveillance over 5 years seems necessary for the detection of delayed-onset biliary stricture after primary biliary reconstruction. Delayed-onset bile duct stricture should be treated on the case-by-case basis, with radiologic intervention or radical biliary reconstruction combined with liver resection.
腹腔镜胆囊切除术（LC）已被公认为各种良性胆囊疾病的主要治疗方式。然而，在接受LC的患者中，胆管损伤的发生率不可忽视。LC所致主要胆管损伤的一期重建效果通常良好，但一小部分患者在随访期间出现了严重的胆管狭窄。我们描述了对5例发生此类迟发性胆管狭窄患者的治疗经验。1例患者在一期肝空肠吻合术后6个月出现胆管狭窄，经放射介入治疗成功。其他4例患者在一期胆管重建术后4至16个月接受了右半肝切除术及再次肝空肠吻合术。平均40个月的随访期间未出现复发性胆管狭窄。总之，对于一期胆管重建术后迟发性胆管狭窄的检测，似乎有必要进行超过5年的长期监测。迟发性胆管狭窄应根据具体情况进行治疗，可采用放射介入治疗或根治性胆管重建联合肝切除术。
