Valentino A
Minerva Chir. 1977 Mar 15;32(5):257-78.
Reconstructive surgery of the bile ways involves a great commitment owing to the technical difficulties, the diversity of the nature, site and extent of the alteration to be treated, and because of the particular anatomical structure of the formations which have to be operated. The conditions that can benefit most from this type of surgery are represented by preoperative lesions of the bile ways and particularly stenoses which but not only follow such lesions if they are not treated in time, but may also follow other processes of a benign nature such as calculosis, cholangitis, anomalies of the bile ways treated wrongly during previous cholecystectomy, and at times malignant processes. Reconstructive surgery in bile way surgery means direct re-establishment of the duct to enable bile to flow from the liver to the duodenum. It presupposes a number of local conditions, such as the circumscription of the condition so that the stenotic segment can be removed and long-lasting end-to-end anastomosis effected. When it is possible, this must be considered the ideal procedure since it offers anatomophysiological recovery of bile way function. Operations have also been performed using various vein, artery, appendix, fascia lata, etc. grafts and prostheses using foreign matter such as rubber, vitallium,dacron, etc. tubes but results have always been hazardous and debatable. Personal cases and techniques are reported.
胆道重建手术由于技术难度大、待治疗病变的性质、部位和范围多样，以及需要手术的结构特殊的解剖学结构，因而需要付出巨大努力。最能从这类手术中获益的情况是术前胆道病变，尤其是狭窄，如果不及时治疗，不仅会出现此类病变，还可能继发其他良性病变，如结石症、胆管炎、既往胆囊切除术中错误处理的胆道异常，有时还会继发恶性病变。胆道手术中的重建手术意味着直接重建管道，使胆汁能够从肝脏流入十二指肠。这需要一些局部条件，如病变的局限性，以便能够切除狭窄段并进行持久的端端吻合。如果可能，这必须被视为理想的手术方法，因为它能使胆道功能在解剖生理学上得以恢复。也有人使用各种静脉、动脉、阑尾、阔筋膜等移植物以及使用橡胶、维氏合金、涤纶等异物制成的假体管道进行手术，但结果一直存在风险且存在争议。本文报告了个人病例和技术。
