本文選題：膽管良性狹窄 + 醫(yī)源性膽管損傷��； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:評(píng)價(jià)自體帶血管蒂的胃瓣組織修復(fù)治療膽管良性狹窄手術(shù)的安全性及遠(yuǎn)期療效。方法:回顧性分析2002-2017年利用自體帶血管蒂的胃瓣修復(fù)治療膽管良性狹窄病例,總結(jié)分析病人手術(shù)時(shí)間、術(shù)中出血、術(shù)后住院時(shí)間、手術(shù)并發(fā)癥以評(píng)價(jià)胃瓣修補(bǔ)術(shù)的安全性,通過術(shù)后隨訪病人膽道系統(tǒng)癥狀、肝功能變化及狹窄復(fù)發(fā)情況評(píng)價(jià)胃瓣修補(bǔ)術(shù)的遠(yuǎn)期療效。結(jié)果:本研究共納入54例患者,共計(jì)行自體帶血管蒂的胃瓣組織修復(fù)膽管良性狹窄55例(一例患者曾行2次胃瓣修補(bǔ)術(shù))。平均手術(shù)時(shí)間253.1±60.7 min,中位術(shù)中出血200.0(100.0,200.0) ml,術(shù)后平均住院時(shí)間12.7±7.2 day。術(shù)后總體并發(fā)癥率為20.0%(11/55),切口延遲愈合6例,膽瘺2例,腹腔包裹性積液,膽道感染,術(shù)后膽道出血各1例。遠(yuǎn)期中位隨訪時(shí)間78(70,104)月,術(shù)后3例患者死于惡性腫瘤,再次手術(shù)3例:其中肝移植術(shù)1例,胃瓣再修補(bǔ)術(shù)1例,結(jié)石復(fù)發(fā)肝方葉切除、Oddi's括約肌成形術(shù)1例。2例肝功能異常,給予利膽藥物治療后好轉(zhuǎn),其余46例患者均未見明顯腹痛、腹脹,且肝功能正常,優(yōu)良率94.1%(48/51)。結(jié)論:自體帶血管蒂的胃瓣修復(fù)治療膽管良性狹窄是一種安全可靠的手術(shù)治療方式,可獲得優(yōu)良的長(zhǎng)期療效。
[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 鹵60.7 min, and the median intraoperative bleeding was 200.0100.0200.0) ml, and the average postoperative hospitalization time was 12.7 鹵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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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