胆肠吻合口狭窄主要原因及对策

中国实用外科杂志2014年10月第34卷第10期其注意打结张力，以免撕裂胆管及肠壁，引起术后吻合口漏。4.3.3吻合口的整形和缝线选择胆肠吻合存在多个胆管开口或胆管口径较细时，需要通过胆管整形提供完整、大小合理的胆管断端。如左、右肝管拼合吻合时，需要剪开左右肝管之间侧壁，缝合拼成一个开口。侧壁剪开的深度为胆管口径的3/4以上。如果存在多个开口（>3个），应尽可能将全部开口拼合成一个大开口，如无法拼合时，则应将左右侧的多个开口分别拼合成左右各一个大开口，分别与空肠吻合［12］。此外选择理想的缝线既能够在愈合过程中维持足够的组织张力，又能够减少组织反应，避免缝线导致的感染。一般选择可吸收缝线进行吻合。4.3.4其他手术要点分离胆管周围粘连时必须彻底止血，视野清楚便于吻合。胆肠吻合口后方应常规放置引

流。引流管不能压迫吻合口。胆肠吻合一般可不放支撑

管，如果胆管水肿严重、胆管口径细，术后存在吻合口狭窄可能，需置管支撑、引流。由于肝右动脉横穿胆管后方入右肝，游离胆总管后方时，注意保护肝右动脉，防止与胆管

一同被游离切断。分离胆总管后壁时，注意勿损伤门静脉。参考文献

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（2014-06-22收稿）作者单位：复旦大学附属中山医院普外科，上海200032

通讯作者：刘厚宝，E-mail：liu.houbao@

文章编号：1005-2208（2014）10-0934-05

DOI:10.7504/CJPS.ISSN1005-2208.2014.10.11

胆肠吻合口狭窄主要原因及对策

刘厚宝，沈盛

【摘要】胆肠吻合术是治疗胆道良恶性疾病、处理医源性

胆管损伤、重建胆汁引流的重要方法，而术后狭窄作为其常见的并发症，是胆道外科中最难以解决的问题之一。胆管自身特点与胆肠吻合术后病理生理改变是吻合口术后

易形成狭窄的基础，而很多外科相关因素是其高发生率的主要原因，如胆道肿瘤的R0切除、肝门胆管整形、结石的复

发、反复胆道感染、缝合材料的选择和手术操作等。基于多学科协作诊治团队模式的个体化治疗、精确的术前评估和精细化手术是目前处理胆肠吻合口术后狭窄的关键。

【关键词】吻合口狭窄；胆肠吻合术

中图分类号：R6文献标志码：A

Main reasons and strategies for anastomotic stricture

following bilioenterostomy LIU Hou-bao,SHEN Sheng.Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai200032,China

Corresponding author:LIU Hou-bao,E-mail:liu.houbao@

Abstract Bilioenterostomy is commonly performed during reconstruction

following resection of benign or malignant

biliary diseases,

and repair of bile duct injury.Anastomotic stricture,as a common complication after bilioenterostomy,is

one of the most complicated problems in biliary surgery.The ·

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