Terblanche J, Worthley C S, Spence R A, Krige J E
Department of Surgery, University of Cape Town, South Africa.
Surgery. 1990 Nov;108(5):828-34.
The 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter. Thirteen of these 22 operations followed a previous biliary tract repair; in 10 of the operations a low anastomosis had been performed without taking blood supply into account. Follow-up was complete and ranged from 5 to 15 years. There were no operative deaths and minimal morbidity. There were three deaths at a later time. Five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result: recurrent strictures developed in all five patients. All but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures. The one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis. The results in the five high repairs performed for low strictures were particularly striking: All five were asymptomatic. This study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy.
1973年至1984年间，我院对19例患者进行了22次胆管狭窄术后修复手术，旨在评估1979年对十二指肠上段胆管脆弱血供的认识是否改善了此后的治疗效果。这22例手术中有13例是在先前胆道修复术后进行的；其中10例手术进行了低位吻合，未考虑血供情况。随访完整，时间跨度为5至15年。无手术死亡，发病率极低。后期有3例死亡。截至1979年，接受手术治疗的11例患者中有5例临床效果不理想：所有5例患者均出现复发性狭窄。1980年接受高位肝空肠吻合术的8例患者中，除1例患者外，其余患者临床效果均令人满意，无复发性狭窄。例外的这例患者进行了第二次修复，分别对左右肝管进行了高位吻合，且因既往继发性硬化性胆管炎持续出现症状。对低位狭窄进行的5次高位修复手术的结果尤为显著：所有5例患者均无症状。本研究支持胆管狭窄缺血性基础的假说，并支持采用高位肝空肠吻合术修复狭窄的建议。
