胆管空肠Roux-en-Y吻合术后胆道感染的病因分析  

Etiologic analysis of infection of biliary tract after bile duct jejunum Roux-en-Y anastomosis

作　　者：孙杰 邓漾[2] 倪克梁 

机构地区：[1]上海市闸北区市北医院普外科,上海200435 [2]上海第二医科大学附属瑞金医院普外科,上海200025

出　　处：《世界感染杂志》2006年第1期52-54,66,共4页World Journal of Infection

摘　　要：目的探讨胆管空肠Roux-en-Y吻合术后胆道感染的发生率及其原因。方法回顾性分析56例行胆管空肠Roux-en-Y吻合术病例术后胆道感染的发生情况以及该术式对改善肝功能的作用和术后并发症。结果56例中术后6例出现胆道感染，占10．7％，平均随访时间为36．8mo。分为胆总管囊肿组、肿瘤组、胆石病组和胆道损伤或狭窄组，除胆总管囊肿组外，其余三组术后肝功能都显著优于术前肝功能。术后并发出血1例，腹腔感染4例，黄疸1例，肺部感染3例，尿路感染1例，应激性溃疡出血1例，败血症1例，切口感染1例，不完全性小肠梗阻1例。对比同期12例既往行胆道空肠吻合术，术后出现胆道感染症状而于我院再次手术的病例，均发现原胆肠吻合口狭窄（9例）以及吻合口以上胆管狭窄（3例）。结论胆管空肠Roux-en-Y吻合术能显著改善病人的肝功能；该术式并发症较低；术后胆道感染的发生率较低；胆道感染的发生与吻合口及吻合口以上胆管的狭窄有关。Objective To comprehend the infectious rate of infection of biliary tract after bile duct jejunum anastomosis. To evaluate complications and effect of improving liver function of this type of operation. Methods Data of 56 cases of bile duct jejunum anastomosis （from July 1997 to Feb 2004） was retrospectively analyzed. Post operation infection of biliary tract and effect of improving liver function of this type of operation were documented. Results 6 episodes of infection of biliary tract （10.7%） were encountered. Mean time of follow-up was 36.8mon, total 56 patients were divided into 4 groups： choledochal cyst group, neoplasm group, cholelithiasis group and injury and constriction of bile duct group. Liver function was significantly improved after operation in 3 groups except choledochal cyst group. 1 case of hemorrhage, 4 cases of peritoneal infection, 1 case of jaundice, 3 cases of pulmonary infection, 1 case of urinary tract infection, 1 case of stress ulcer, 1 case of sepsis, 1 case of incision infection and 1 case of incomplete intestinal obstruction were encountered after operation. Other 12 cases of stoma re-constriction after bile duct jejunum anastomosis were also documented. 9 cases of stoma constriction and 3 cases of constriction of bile duct above stoma were confirmed during second time operation. Conclusions Bile duct jejunum anastomosis could significantly improve the liver function with lower post operation infection rate. The episode of infection of biliary tract may have relationship with constriction of stoma or bile duct above stoma.

关 键 词：胆管空肠ROUX-EN-Y吻合术 胆道感染 胆管结石 

分 类 号：R575.7[医药卫生—消化系统]