胆肠吻合术后吻合口狭窄45例临床分析和再处理  

CLINIC ANALYSIS AND RE-MANAGEMENT OF 45 CASE AFTER CHOLANGIOENTEROSTOMY WITH HILAMRIETURE OF ANASTOMOTIC STOMA

作　　者：甄茂椅[1] 吴立胜[1] 涂从银[1] 蔡守旺[2] 汪宏[1] 沈毅[1] 翟荣幸[1] 

机构地区：[1]合肥市第一人民医院,合肥230061 [2]解放军总医院

出　　处：《肝胆外科杂志》2006年第6期425-427,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆肠吻合术后胆肠吻合口狭窄的原因,以提高外科治疗水平。方法回顾性分析2000～2006年收集的45例病人行胆肠内引流手术发生胆肠吻合口狭窄再手术的资料,总结临床经验教训。结果45例病人中41例再手术治疗,其中39例行胆管空肠端侧Roux-en-Y吻合,1例行带蒂空肠瓣胆道修补重建术,1例更换U管;3例采取非手术治疗(其中1例为肝移植术后),1例家属放弃治疗(肝门部胆管癌复发),随访0.5～5年,5例(5/41)病人出现胆道感染症状,其中1例(1/41)为右肝残余结石。结论胆肠吻合术后吻合口狭窄主要原因首先为吻合方式不当,其次是病灶未能很好清除、引流不畅,再者应为吻合技术欠佳及使用材料不当。Objective To investigate the mason of anastomotic stoma after bilioenterostomy and to improve surgical management level. Methods From 2000 to 2006,45 patients underwent different typers of cholangioenterostomy were received surgerieal retreatment with hilamrieture of anastomotie stoma. Clinical date of the patients were retrospectively analyzed and summarized. Result 41 patients were accepted reoperation. Of that cases,39 were subjected to Roux-en-Y anastomosis, 1 to restore biliary utilized jejunum, 1 to change U tube . there were 3 cases subjected to non-operation and 1 case was abandened to treatment further for proximal cholagio- cacinoma palindromia . The follow-up of 41 cases for 0. 5 - 5 years 5 cases still has symptom of infection of biliary tract , of which 1 （1/40） was diagnosed residual stone in fight liver. Conclusion The badly operative model selection are the major reasons of hilamfieture of anastomotic stoma after cholangioenterostomy, and inadequate drainage、badly technique and material selection by turns.

关 键 词：胆道 胆肠吻合术 吻合口 狭窄 再手术 

分 类 号：R657.4[医药卫生—外科学]