Etiology and surgical treatment of hilar bile duct stricture.
OBJECTIVE
To improve the surgical effects of hilar duct stricture.


METHODS
The clinical data of 76 patients with hilar bile duct stricture treated at our hospital from 1990 to 2000 were analyzed. The diagnosis was determined by triad signs of cholangitis, increase of ALP and gamma-GGT levels, dilation of intrahepatic and extrahepatic bile ducts confirmed by ultrasonography (US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP). The location of stricture was divided according to the Bismuth classification standard.


RESULTS
Among the 76 patients, 46 (60.5%) suffered from injurious stricture, including 13% of Bismuth type I, 39% of type II, 19.4% of type III, and 28.2% of type IV. Inflammatory stricture was found 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. The percentages of patients with stricture due to Mirizzi's syndrome, bile duct cyst, and sclerosing cholangitis were 9.2%, 3.9% and 2.6%, respectively. Bile duct repair procedures included biliary reconstruction with pedicled umbilical vein graft for 9.2% of the patients, and proximal cholangiojejunostomy combined with LHD and RHD plasticity for 92.2%. Seventy of the 76 patients were followed 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 stricture is mainly composed of RHD. Hilar bile duct stricture should be treated surgically according to various etiological features and technical principles of biliary repair.
He
Zhen-Ping
ZP
Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. hezhenping@yahoo.263.net
Hou
Wen-Lin
WL
Bie
Ping
P
Dong
Jia-Hong
JH
Wang
Shu-Guang
SG
Han
Ben-Li
BL
Cai
Jin-Xiu
JX
Li
Zhi-Hua
ZH
Chen
Ping
P
Ma
Kuan-Sheng
KS
Zheng
Shu-Guo
SG
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002780:Cholestasis, Intrahepatic / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome