Myburgh J A
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Ann Surg. 1993 Nov;218(5):615-20. doi: 10.1097/00000658-199321850-00005.
The results of operative repair of benign strictures of the bile duct after cholecystectomy, right hemihepatectomy, vagotomy and antrectomy, choledochal cysts in adults, and chronic pancreatitis, with particular reference to the use of the Hepp technique for hilar strictures and without the use of transanastomotic tubal stenting, were analyzed in 44 patients.
End-to-side bilio-enteric anastomoses have been reported to be associated with restricturing and reoperation in 12% to 25% of cases and operative morbidity and mortality rates of 10% and 5% to 8%, respectively. Long-term transanastomotic tubal stenting is widely practiced in an attempt to prevent or diminish anastomotic stricturing.
The Hepp technique of wide, accurate, mucosa-to-mucosa anastomosis between the left hepatic duct and a jejunal Roux loop was used in 28 patients with hilar bile duct strictures. The same technical principle of wide side-to-side anastomosis was used in most of the lower strictures. Patients have been observed for 1 to 14 years (median, 7 years).
The operative mortality rate was 7% (3 patients), but only 2.4% (1 patient) in 41 noncirrhotic patients. Two patients who had undergone standard end-to-side hepaticojejunostomy required reoperation (Hepp procedures) for recurrent strictures. No recurrent strictures occurred with the use of the Hepp technique for hilar strictures or wide side-to-side anastomosis for lower strictures. None of these patients experienced episodes of ascending cholangitis.
The Hepp approach provides a safe, durable, and highly effective solution to the problem of strictures of the bile duct, including hilar strictures. Transanastomotic tube stenting is not necessary.
分析44例患者在胆囊切除术、右半肝切除术、迷走神经切断术和胃窦切除术、成人先天性胆管囊肿以及慢性胰腺炎后，胆管良性狭窄的手术修复结果，尤其涉及Hepp技术用于肝门部狭窄且不使用经吻合口胆管支架置入术的情况。
据报道，端侧胆肠吻合术在12%至25%的病例中与吻合口狭窄及再次手术相关，手术发病率和死亡率分别为10%以及5%至8%。长期经吻合口胆管支架置入术被广泛应用，旨在预防或减轻吻合口狭窄。
28例肝门部胆管狭窄患者采用Hepp技术，即左肝管与空肠Roux袢之间进行广泛、精确的黏膜对黏膜吻合。大多数低位狭窄采用相同的广泛侧侧吻合技术原则。对患者进行了1至14年（中位时间为7年）的观察。
手术死亡率为7%（3例患者），但在41例非肝硬化患者中仅为2.4%（1例患者）。2例接受标准端侧肝管空肠吻合术的患者因复发性狭窄需要再次手术（Hepp手术）。采用Hepp技术治疗肝门部狭窄或广泛侧侧吻合治疗低位狭窄均未出现复发性狭窄。这些患者均未发生上行性胆管炎。
Hepp方法为胆管狭窄问题，包括肝门部狭窄，提供了一种安全、持久且高效的解决方案。无需经吻合口胆管支架置入。
