Grill W, Hermes K
Langenbecks Arch Chir. 1980;353(2):105-19. doi: 10.1007/BF01254772.
Iatrogenic lesions of the hepatocholedochus are among the most serious complications of upper abdominal surgery. They present the surgeon with difficult problems: unsuccessful attempts to reconstruct easily lead to irreparable liver damage and situations which can no longer be controlled surgically. Consequently, the corrective operation decides the fate of the patient. Contrary to general opinion, we attempt the ideal bilibiliary end-to-end anastomosis over the large T-drain after mobilization of the stump of the biliary tract even in larger defects. With proper mobilization, even defects of the hepatocholedochus up to 4 cm long can be bridged. Naturally, preparation of the distal limb of the bile duct requires adequate surgical experience. We have performed 40 bilibiliary end-to-end anastomoses in 37 patients. Examination and follow-up examinations showed, apart from one death and three reoccurrences of stenosis, satisfactory results in every respect: The successful bilibiliary end-to-end anastomosis is superior to all other corrective measures.
肝外胆管医源性损伤是上腹部手术最严重的并发症之一。它们给外科医生带来了难题：重建手术的失败很容易导致不可修复的肝脏损伤以及无法再通过手术控制的情况。因此，矫正手术决定着患者的命运。与普遍观点相反，即使存在较大缺损，我们仍会在胆道残端游离后通过大T形引流管尝试进行理想的胆管端端吻合术。通过适当的游离，即使长达4厘米的肝外胆管缺损也能够被修复。当然，胆管远端的准备需要足够的手术经验。我们已为37例患者进行了40例胆管端端吻合术。检查及随访结果显示，除1例死亡和3例狭窄复发外，各方面结果均令人满意：成功的胆管端端吻合术优于所有其他矫正措施。
