良性胆道狭窄症例の検討

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  • THE MANAGEMENT OF BENIGN BILE DUCT STRICTURES

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Benign bile duct strictures have varicolored origin and high morbidity. In an effort to evaluate the spectrum of these strictures, a retrospective analysis was carried out on 105 consecutive patients with benign duct stricture treated at the department between 1985 and 1994. These 105 lesions represented 6.0% of all benign bile duct diseases. Bile duct damage was most frequently found in the middle-lower bile duct area (74.5%). The stricutres were caused by non-operative factorsin 81.5% and operative factors in 18.5%. Among non-operative factors Vater's stricture and congenital disease were common. Operative factors included intraoperative bile duct injury in 8 cases and postoperative cicatrization in 10 cases. After biliary reconstruction, stricture occured at the anastomosed site in 4 cases. As to postoperative strictures, it occurred in 4 (1.66%) out of 236 cases undergoing choledochodrainage by inserting a T tube; in 2 (0.16%) out of 1256 cases undergoing cholecystectomy; and in 4 olut of 374 cases undergoing biliary reconstruction. The postoperative strictures had an average disease-free period of 2.12 years after the operation for the primary disease. As to treatments of the stricture, standard operation was done for 98 cases and interventional radiologic technique for 6 cases. The standard operation was successful in 91 (92.9%) and the interventional techniques in 5 (83%) cases. Judging from our experience with the period of presence of the stricuture, grade of inflammation and damage of bile duct, it is suggested that choledochojejunostomy is superior to other anastomosis methods.

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