Sugawara Gen, Ebata Tomoki, Yokoyama Yukihiro, Igami Tsuyoshi, Mizuno Takashi, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Hepatobiliary Pancreat Sci. 2014 Dec;21(12):889-95. doi: 10.1002/jhbp.151. Epub 2014 Aug 26.
Biliary strictures following laparoscopic cholecystectomy (Lap-C), which are often associated with vascular injuries, remain a serious problem to manage. The aim of this study was to review our experiences with postoperative biliary stricture.
This study involved 14 consecutive patients with biliary strictures that resulted from bile duct injuries during Lap-C between 1997 and 2013. Their medical records were retrospectively analyzed.
Percutaneous transhepatic biliary drainage (PTBD) catheter dilatation was first attempted in eight patients, and five patients were successfully treated. Biliary re-stricture recurred in one patient after 34-month follow-up period. This patient underwent repeated catheter dilatations, which led to recurrent stricture resolution. All five patients maintained biliary tract patency over 72-month follow-up period. The remaining nine patients underwent surgical procedures, including hepaticojejunostomy in two patients, re-hepaticojejunostomy in two patients, and the remaining five patients, with biliary strictures involving the secondary biliary branch and concomitant vascular injuries underwent right hemihepatectomy with cholangiojejunostomy. There were no major postoperative complications. After 80-month follow-up period, all nine patients were alive without biliary stricture.
PTBD catheter dilatation is recommended first for postoperative Lap-C-associated biliary strictures. In complicated injury patients with vascular injuries, right hemihepatectomy with cholangiojejunostomy should be indicated.
腹腔镜胆囊切除术（Lap-C）后发生的胆管狭窄常与血管损伤相关，仍是一个难以处理的严重问题。本研究的目的是回顾我们处理术后胆管狭窄的经验。
本研究纳入了1997年至2013年间14例因Lap-C术中胆管损伤导致胆管狭窄的连续患者。对他们的病历进行回顾性分析。
8例患者首先尝试经皮肝穿刺胆道引流（PTBD）导管扩张，5例患者成功治疗。1例患者在34个月的随访期后胆管再次狭窄复发。该患者接受了反复的导管扩张，最终狭窄复发得以缓解。所有5例患者在72个月的随访期内均保持胆道通畅。其余9例患者接受了手术治疗，包括2例行肝空肠吻合术，2例行再次肝空肠吻合术，其余5例胆管狭窄累及二级胆管分支并伴有血管损伤的患者接受了右半肝切除术加胆管空肠吻合术。术后无重大并发症。在80个月的随访期后，所有9例患者均存活，无胆管狭窄。
对于Lap-C术后相关胆管狭窄，建议首先采用PTBD导管扩张。对于伴有血管损伤的复杂损伤患者，应行右半肝切除术加胆管空肠吻合术。
