Latteri S, Vecchio R, Angilello A
Dipartimento di Chirurgia, Università degli Studi di Catania.
G Chir. 1997 Jan-Feb;18(1-2):61-4.
Pathogenetic, diagnostic and therapeutic aspects of postoperative bile duct injuries are reviewed. Treatment options are discussed in relation to the time of diagnosis. Lesions detected during the same operation must be immediately repaired through an end-to-end biliary anastomosis or a bilioenteric anastomosis. In limited lesions of the bile duct a T-tube placement should be sufficient. Bile duct lesions recognized postoperatively can be managed through a multimodal surgical, endoscopic, and radiologic approach. In the early postoperative period, surgery is indicated when a complete section of the biliary tract or a severe peritonitis is recognized, or when endoscopic and radiologic treatment has failed. Surgery is also the treatment of choice in the late complete stenosis of the bile duct. Roux-en-Y hepatico-jejunostomy is the most common surgical procedure for the treatment of bile duct lesions and strictures. However, in high bile duct lesions, especially if the risk of anastomotic dehiscence is increased the Authors emphasize the Rodney-Smith technique for the reconstruction of the biliary tract.
本文综述了术后胆管损伤的发病机制、诊断及治疗方面。结合诊断时间讨论了治疗方案。在同一手术过程中发现的病变必须立即通过胆管端端吻合术或胆肠吻合术进行修复。对于胆管的局限性病变，放置T管应足够。术后发现的胆管病变可通过多模式手术、内镜及放射学方法处理。在术后早期，当识别出胆管完全离断或严重腹膜炎，或内镜及放射学治疗失败时，需进行手术。手术也是胆管晚期完全狭窄的首选治疗方法。Roux-en-Y肝空肠吻合术是治疗胆管病变和狭窄最常用的手术方法。然而，对于高位胆管病变，尤其是吻合口漏风险增加时，作者强调采用罗德尼-史密斯技术重建胆道。
