中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (03): 206-207.

• 论著 • 上一篇    下一篇

显露十二指肠后段胆管在多次胆道手术病人中的应用

李可洲，骆助林，闫洪涛，戴睿武，闫    勇，刘湘林，田伏洲   

  1. 成都军区总医院全军普通外科中心，四川成都610083
  • 出版日期:2010-03-01 发布日期:2010-03-12

  • Online:2010-03-01 Published:2010-03-12

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摘要：

目的    探讨胆道再手术中寻找胆管的有效方法。方法    分析总结成都军区总医院1999年10月至2008年10月间胆道多次手术后再次行胆道手术的病例共2457例，其中31例因术中常规方法寻找胆管困难而采用了显露十二指肠后段法-游离下降十二指肠球部显露解剖相对正常的十二指肠后段胆管，成功后向上游离切开至肝门处再行相应操作。结果    采用显露十二指肠后段法的病倒占同期多次手术病例的1.16%（31/2457），31例通过该法全部成功解剖出肝外胆管。游离操作时间短，出血量少。该组病例的腹腔引流量、胃肠道功能恢复时间等指标均较常规方法操作病例差异无统计学意义。结论    胆道再手术时分离寻找胆管有时极为困难。显露十二指肠后段法操作简便、成功率高，可作为其他方法的有益补充。

关键词: 再手术, 肝外胆管, 十二指肠, 肝胆管结石病

Abstract:

The Effect of Dudenum-Decending Method on Biliary Duct Reoperation in Patients with Repeated Biliary Operation        LI Ke-zhou, LUO Zhu-lin, YAN Hong-tao, et al.PLA General Surgery Center, Chengdu Military General Hospital, Chengdu610083,China.
Corresponding author：LI Ke-zhou, E-mail：kzlchina@yahoo.com
Abstract    Objective    Here we introduce our expierance on searching biliary duct in some difficult condition in biliary reoperation. Methods    The data of 2457 cases with reoperation on biliary tract after repeated biliary operations over the past 10 years was analyzed. Duodenum-decending method was used in 31 cases when failed with conventional method. The duodenal bulb was freed and decended to expose the relatively normal posterior duodenal part of extra hepatical biliary duct, the duct was freed and incised upward to the hepatic porta,then accomplied with succeded operation manuver. Results    The cases operated with duodenum-drop method accounted for 1.16 percent (31/2457) of the patients during the same period. All the 31 cases were found extra hepatical duct successfully by this method, with operation time of 3~5mins (average 4.5 min), and blood loss of 1.5~2.0ml (average 1.8ml). There were no significant difference in abdominal drainage and gastrointestinal function recovery between duodenum-drop method group and conventional method group. Conclusion    Separating and finding the bile duct is sometimes very difficult in biliary reoperation. Duodenum-drop method is feasable and with high success rate,which can be used as a useful complement to other conventional methods.

Key words: reoperation, extrahepatic bile duct, duodenum, hepatolithiasis