自体带血管蒂的胃瓣组织修复治疗胆管良性狭窄的研究

发布时间：2018-05-19 17:30

本文选题：胆管良性狭窄 + 医源性胆管损伤　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的:评价自体带血管蒂的胃瓣组织修复治疗胆管良性狭窄手术的安全性及远期疗效。方法:回顾性分析2002-2017年利用自体带血管蒂的胃瓣修复治疗胆管良性狭窄病例,总结分析病人手术时间、术中出血、术后住院时间、手术并发症以评价胃瓣修补术的安全性,通过术后随访病人胆道系统症状、肝功能变化及狭窄复发情况评价胃瓣修补术的远期疗效。结果:本研究共纳入54例患者,共计行自体带血管蒂的胃瓣组织修复胆管良性狭窄55例(一例患者曾行2次胃瓣修补术)。平均手术时间253.1±60.7 min,中位术中出血200.0(100.0,200.0) ml,术后平均住院时间12.7±7.2 day。术后总体并发症率为20.0%(11/55),切口延迟愈合6例,胆瘘2例,腹腔包裹性积液,胆道感染,术后胆道出血各1例。远期中位随访时间78(70,104)月,术后3例患者死于恶性肿瘤,再次手术3例:其中肝移植术1例,胃瓣再修补术1例,结石复发肝方叶切除、Oddi's括约肌成形术1例。2例肝功能异常,给予利胆药物治疗后好转,其余46例患者均未见明显腹痛、腹胀,且肝功能正常,优良率94.1%(48/51)。结论:自体带血管蒂的胃瓣修复治疗胆管良性狭窄是一种安全可靠的手术治疗方式,可获得优良的长期疗效。
[Abstract]:Objective: to evaluate the safety and long-term effect of repair of gastric flap with autogenous vascular pedicle for benign stricture of bile duct. Methods: the patients with benign stricture of bile duct were treated with autogenous vascular pedicled gastric flap from 2002 to 2017. The operative time, intraoperative bleeding, postoperative hospital stay and postoperative complications were analyzed retrospectively to evaluate the safety of gastric valve repair. The long-term outcome of gastric valve repair was evaluated by following up the patients with biliary system symptoms, liver function and recurrence of stenosis. Results: a total of 54 patients were included in this study. 55 cases of benign stricture of bile duct were repaired with autogenous vascular pedicled gastric flap. The mean operative time was 253.1 卤60.7 min, and the median intraoperative bleeding was 200.0100.0200.0) ml, and the average postoperative hospitalization time was 12.7 卤7.2day. The overall complication rate was 20.0 / 55%, 6 cases were delayed healing of incision, 2 cases were biliary fistula, 1 case was intraperitoneal effusion, 1 case was biliary tract infection, and 1 case was postoperative biliary bleeding. The long term median follow-up time was 78 / 70104 months. 3 patients died of malignant neoplasms after operation and 3 patients underwent reoperation: liver transplantation in 1 case, gastric flap repair in 1 case, sphincteroplasty of oddides in 1 case with recurrent hepatectomy, and hepatic function abnormality in 2 cases. The other 46 patients had no obvious abdominal pain, abdominal distention and normal liver function. The excellent and good rate was 94.1g / 48 / 51. Conclusion: the repair of autogenous vascular pedicled gastric flap for benign bile duct stenosis is a safe and reliable surgical treatment and can obtain good long-term curative effect.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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