title: Etiology and surgical treatment of hilar bile duct stricture.
abstract: 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.
authors: Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. hezhenping@yahoo.263.net
authors: Zhen-Ping
authors: ZP
authors: He
authors: Wen-Lin
authors: WL
authors: Hou
authors: Ping
authors: P
authors: Bie
authors: Jia-Hong
authors: JH
authors: Dong
authors: Shu-Guang
authors: SG
authors: Wang
authors: Ben-Li
authors: BL
authors: Han
authors: Jin-Xiu
authors: JX
authors: Cai
authors: Zhi-Hua
authors: ZH
authors: Li
authors: Ping
authors: P
authors: Chen
authors: Kuan-Sheng
authors: KS
authors: Ma
authors: Shu-Guo
authors: SG
authors: Zheng
mesh_terms: 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