Etiology and surgical treatment of hilar bile duct stricture

作     者：Zhen-Ping He Wen-Lin Hou Ping Bie Jia-Hong Dong Shu-Guang Wang Ben-Li Han Jin-Xiu Cai Zhi-Hua Li Ping Chen Kuan-Sheng Ma Shu-Guo Zheng 

作者机构：Institute of Hepatobiliary Surgery Southwest Hospital Third Military Medical University Chongqing 400038 China. hezhenping@*** 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2003年第2卷第4期

页      面：587-593页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：stricture bile duct operation repair 

摘      要：OBJECTIVE: To improve the surgical effects of hilar duct ***: The clinical data of 76 patients with hilar bile duct stricture treated at our hospital from1990 to 2000 were analyzed. The diagnosis was determined by triad signs of cholangitis, increase of ALPand γ-GGT levels, dilation of intrahepatic and extrahepatic bile ducts confirmed by ultrasonography(US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC) or endoscopicretrograde cholangiopancreatography (ERCP). The location of stricture was divided according to theBismuth classification ***: Among the 76 patients, 46 (60.5%) suffered from injurious stricture, including 13% ofBismuth type Ⅰ, 39% of type Ⅱ, 19.4% of type Ⅲ, and 28.2% of type Ⅳ. Inflammatory stricture wasfound in 28 patients, locating in the left hepatic duct (LHD) 46.4% (13/28), the right hepatic duct(RHD) 35.7% (10/28), and the common hepatic duct (CHD) 17.9% (5/28), respectively. Thepercentages of patients with stricture due to Mirizzi’s syndrome, bile duct cyst, and sclerosingcholangitis were 9.2%, 3.9% and 2.6%, respectively. Bile duct repair procedures included biliaryreconstruction with pedicled umbilical vein graft for 9.2% of the patients, and proximalcholangiojejunostomy combined with LHD and RHD plasticity for 92.2% Seventy of the 76 patients werefollowed up for 2-10 years, and the excellent outcome rate was 94.7%.CONCLUSIONS: Injurious stricture is the major type of hilar bile duct stricture. Inflammatory strictureis mainly composed of RHD. Hilar bile duct stricture should be treated surgically according to variousetiological features and technical principles of biliary repair.