胆管空肠Roux-Y吻合术后胆道感染发生的原因  

The causes of biliary infection after bile duct jejunum Roux-Y anastomosis

作　　者：邓漾[1] 韩天权[1] 吴卫泽[1] 王建承[1] 费健[1] 朱坚[1] 秦俭[1] 秦钧[1] 田锐[1] 张圣道[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《肝胆胰外科杂志》2007年第5期281-284,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金资助项目(30672042)

摘　　要：目的探讨胆管空肠Roux-Y吻合术后胆道感染的发生率及其原因。方法回顾研究1997年7月~2004年10月行胆管空肠Roux-Y吻合术62例,以及12例既往行胆管空肠Roux-Y吻合术,因胆道感染入我院再次手术的病例资料。结果62例中7例（占11.3%）出现术后胆道感染,平均随访44.1月,4例再手术,均发现胆管空肠Roux-Y吻合口狭窄。有吻合口直径资料56例,吻合口直径≤2.0 cm的20例中5例（占25.0%）出现术后胆道感染;直径〉2.0 cm,36例中仅1例（占2.8%）出现胆道感染。在12例胆管空肠吻合术后胆道感染再次手术病例中,发现原吻合口狭窄8例（占66.7%）,吻合口以上胆管狭窄3例,1例空肠失功肠襻胆石性肠梗阻。结论胆管空肠Roux-Y吻合术后胆道感染的发生率较低;胆道引流不畅是胆管空肠Roux-Y吻合术后发生胆道感染的主要原因,吻合口狭窄是术后胆道引流不畅的重要因素。To probe the incidence and causes of infection of biliary tract after bile duct jejunum Roux-Y anastomosis. Methods Sixty-two cases with bile duct jejunum Roux-Y anastomosis （from July 1997 to Oct 2004） were retrospectively studied. Post-operative biliary infection of this type of operation were documented. Other twelve cases with stoma reconstruction and biliary infection after bile duct jejunum Roux-Y anastomosis was also analyzed. Results Seven episodes of biliary infection （11.3%） were encountered. Mean time of follow-up was 44.1 months. The re-operation was performed for 4 patients in our hospital. Constriction of stoma was found in all cases during the reoperation. Fifty-six patients with operation records of stoma were also divided into two groups according to diameter of stoma： Group A （≤2.0 cm） and group B （〉2.0 cm）. Five episodes of biliary infection were encountered in group A, just one episode of biliary infection was encountered in group B. Other twelve cases of stoma reconstruction and biliary infection after bile duct jejunum Roux-Y anastomosis were also documented. Eight cases of stoma constriction, three cases of constriction of bile duct above stoma and one case of gallstone obstruction of afferent loop of bile duct jejunum Roux-Y anastomosis were confirmed during second time of operation. Conclusions Post-operative infection rate of bile duct jejunum Roux-Y anastomosis is low. Inadequate biliary drainage is the major cause of infection of biliary tract after bile duct jejunum Roux-Y anastomosis. Stenosis of stoma is the major factor of inadequte biliary drainage.

关 键 词：胆管空肠ROUX-Y吻合术 胆道感染 胆管结石 

分 类 号：R657.4[医药卫生—外科学]