Henrich M
Chirurg. 1978 Nov;49(11):684-7.
Operative tactics in reconstructive surgery of the common bile duct depend on localization of the lesions or strictures and special topography of this region. At first, it must be decided whether a direct suture seems to be practicable or a biliodigestive anastomosis has to be constructed. There is a better chance to succeed in performing an end-to-end anastomosis the farther away the occlusion is situated from the liver hilus. The main advantage of this procedure can be seen in the restoration of physiological bile discharge. Frequently, however, it shows a tendency to shrink even years later. Often--for establishing a choledochocholedochostomy without tension--it is an important fact that the terminal common bile duct can be partially removed from the pancreas and thereby lengthened for 1--2 cm at the most. From this point of view, the topographic details particularly concerning reconstructive surgery of the common bile duct are described, based on post mortem studies of 48 human cadavers.
胆总管重建手术的操作策略取决于病变或狭窄的位置以及该区域的特殊解剖结构。首先，必须确定直接缝合是否可行，还是必须构建胆肠吻合术。梗阻部位离肝门越远，进行端端吻合成功的机会就越大。该手术的主要优点在于恢复生理性胆汁引流。然而，它常常甚至在数年后仍有收缩的趋势。通常，为了无张力地进行胆总管对端吻合术，一个重要的事实是，可以将胆总管末端部分从胰腺中游离出来，从而最多延长1 - 2厘米。从这一观点出发，基于对48具人类尸体的尸检研究，描述了特别是与胆总管重建手术相关的解剖细节。
