Csendes A, Burdiles P, Diaz J C, Maluenda F
Department of Surgery, Clinical Hospital, University of Chile, Santiago.
Am Surg. 1993 Oct;59(10):629-31.
During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract surgery at the Department of Surgery, University of Chile Clinical Hospital. Of these, seven female adults with a mean age of 39.7 years (range 29 to 54) were considered for analysis in this study. The results of the Heineke-Mikulicz type choledochoplasty repair in patients with short localized strictures of the biliary tract were analyzed in these patients. In six cases, the repair was performed at a mean time of 20 months after cholecystectomy and accidental injury of the common bile duct; in one case it was carried out during cholecystectomy and repair of a Mirizzi type II cholecysto-hepatic fistula. This patient remained asymptomatic during a follow-up of 120 months. Of the six cases on whom choledochoplasty was performed as treatment of short strictures, five patients (83%) developed a new stricture at a mean time of 14 months after surgery; a hepatico-jejunostomy was performed in all. After this procedure, only one patient was re-operated again, and all remained asymptomatic long after surgery. We believe that this Heineke-Mikulicz type choledochoplasty, which has been recommended in short distal strictures, is not advisable as a definitive surgical repair for this kind of stricture.
在1970年至1991年的20年期间，智利大学临床医院外科共有30800例患者接受了胆道手术。其中，7名成年女性被纳入本研究分析，她们的平均年龄为39.7岁（范围29至54岁）。对这些患者中胆道局限性短狭窄患者行海涅克-米库利奇（Heineke-Mikulicz）式胆总管成形术修复的结果进行了分析。6例患者在胆囊切除术后平均20个月、胆总管意外损伤后进行修复；1例在胆囊切除术及米里齐（Mirizzi）II型胆囊肝瘘修复术中进行。该患者在120个月的随访期间无症状。在作为短狭窄治疗而行胆总管成形术的6例患者中，5例（83%）在术后平均14个月出现新的狭窄；均行了肝空肠吻合术。此手术后，仅1例患者再次接受手术，术后所有患者均长期无症状。我们认为，海涅克-米库利奇式胆总管成形术虽被推荐用于远端短狭窄，但作为这种狭窄的确定性手术修复并不可取。
