Hellinger A, Lange R, Peitgen K, Stephan V, Krause U, Erhard J
Abt. f. Allgemeine Chirurgie, Universität-GH-Essen.
Zentralbl Chir. 1997;122(12):1092-8.
From 1/1991 to 1/1997 a total of 18 patients with major biliary lesions after laparoscopic cholecystectomy were treated. Besides 4 biliary strictures (Bismuth III, Siewert II), which were found between 20 and 180 days after laparoscopic cholecystectomy, large defects (Siewert III, IV) of the proximal parts of the hepatic duct (Bismuth III, IV) occurred in the majority of cases (n = 14). Except for 3 intraoperatively realized lesions, diagnosis was made during the first 3 weeks. Subsequent reinterventions resulted in a high morbidity rate and the need of further procedures to establish definitive biliary reconstruction. Selection criteria of the technique used for repair were the extension of the biliary lesion and the exposure of the distal stump of the common bile duct. A small defect was treated by direct suturing protected by a t-tube (n = 1). Large defects and biliary strictures were reconstructed using either a Roux-en-Y bilio-digestive anastomosis (n = 7) or jejunal interposition (n = 10). The results suggest, that early repair of biliary lesions after laparoscopic cholecystectomy should be achieved. Besides the standard procedure of bilio-digestive anastomosis, reconstruction of major biliary lesions should be performed by jejunal interposition in selected cases.
从1991年1月至1997年1月，共治疗了18例腹腔镜胆囊切除术后出现严重胆管病变的患者。除了4例胆管狭窄（Bismuth III型，Siewert II型），这些狭窄在腹腔镜胆囊切除术后20至180天被发现外，大多数病例（n = 14）出现了肝管近端的大缺损（Siewert III型，IV型）（Bismuth III型，IV型）。除了3例术中发现的病变外，诊断均在最初3周内做出。随后的再次干预导致了高发病率，并且需要进一步的手术来建立确定性的胆管重建。用于修复的技术的选择标准是胆管病变的范围和胆总管远端残端的暴露情况。小缺损通过t形管保护下的直接缝合进行治疗（n = 1）。大缺损和胆管狭窄采用Roux-en-Y胆肠吻合术（n = 7）或空肠间置术（n = 10）进行重建。结果表明，腹腔镜胆囊切除术后胆管病变应尽早修复。除了胆肠吻合的标准手术外，在某些选定的病例中，应通过空肠间置术进行主要胆管病变的重建。
