Kune G A
Aust N Z J Surg. 1979 Feb;49(1):35-40. doi: 10.1111/j.1445-2197.1979.tb06433.x.
Bile duct injury during cholecystectomy is almost always a high injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restricturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux-en-Y, using transhepatic intubation and a "mucosal graft" type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting in six recurrent strictures needing a second reconstruction. At the end of 1978, 10 patients are too early to evaluate, two are dead and 20 have obtained a good final result.
胆囊切除术期间的胆管损伤几乎总是肝总管近端的高位损伤，因为外科医生将此胆管误认作胆囊管，其一部分随胆囊被切除。遵循手术期间仔细解剖胆管系统的某些原则，大多数此类损伤是可预防的。手术重建总是困难的，吻合口狭窄仍然是最重要的问题。手术技术的最新进展已将复发性狭窄形成的风险降至最低。目前，对于典型的高位肝总管病变，最合适的重建方法是肝空肠吻合术Roux-en-Y，采用经肝插管和“黏膜移植”式手术。在过去13年中，笔者对32例患者进行了胆道重建，结果有6例复发性狭窄需要再次重建。到1978年底，10例患者因时间太早无法评估，2例死亡，20例获得了良好的最终结果。
