摘要目的 探讨肝圆韧带途径在肝门部胆管良性狭窄疾病中的应用价值.方法 回顾性分析2016年3月至2018年3月湖南省人民医院收治的62例肝门部胆管良性狭窄患者的临床资料.结果 62例肝门部胆管狭窄的病因依次为肝胆管结石(37例),医源性近段胆管损伤(12例),胆肠吻合口再次狭窄(7例),胆管囊状扩张症(4例),桥袢结石(2例).本组患者均经肝圆韧带途径成功进入肝内胆管,行肝门胆管整形,胆管盆式内引流术,平均历时230.3 min,平均失血量196.8 ml.按照Clavien-Dindo评分系统,Ⅰ级并发症32例,Ⅱ级并发症3例,无Ⅲ级以上并发症.出院后经过门诊、电话随访1～24个月,3例患者发生返流性胆管炎,尚未发现胆肠吻合口再次狭窄的病例.结论 肝圆韧带途径是一条解除肝门部胆管良性狭窄、进入肝内胆管的有效途径.

abstractsObjective To explore the value of round ligament approach in the bile duct benign stricture near porta hepatis.Methods Data of 62 patients treated in Hunan Provincial People's Hospital from Mar 2016 to Mar 2018 were retrospectively analyzed.Results Hepatolithiasis was the cause of bile duct benign stricture in 37 cases,followed by iatrogenic injury (12 cases),cholangio-intestinal anastomotic restenosis (7 cases),cystic dilatation of bile duct (4 cases) and bridge-shaped calculus (2 cases).We get access to the strictured bile duct near porta hepatis by way of round ligament,and hilar cholangioplasty and bilioenteric anastomosis was done at the porta hepatis.The surgery lasted an average of 230.3 minutes and with an average 196.8 ml blood loss.By Clavien-Dindo scoring system,there were Grade Ⅰ complications in 32 cases,Grade Ⅱ complications in 3.On follow-up survey,there were 3 patients with reflux cholangitis.Condclsion Round ligament is a gateway to hilar bile duct benign stricture in an attempt to make hilar cholangioplasty.