对大口径胆肠吻合术的再认识（附63例分析）  

Recognition for heavy-caliber cholangioenterostomy（ report of 63 cases ）

作　　者：张雷[1] 王秀珍[1] 尹文州[2] 郑刚[1] 吴建华[1] 杨玉国[3] 沈伟[1] 马祖泰[1] 

机构地区：[1]南京中医药大学附属医院徐州市中医院外科,221003 [2]南京中医药大学附属医院徐州市中医院影像科,221003 [3]江苏省沛县华佗医院外科

出　　处：《中国医师进修杂志（外科版）》2007年第12期7-8,30,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的总结分析大口径胆肠吻合术的手术治疗方法及效果。方法回顾性分析用胆总管或肝总管斜面与肠管侧壁大口径吻合行胆道内引流术63例患者的资料，总结临床经验教训。其中53例行胆管空肠端侧Roux—en—Y吻合术，10例行胆管十二指肠端侧吻合术。结果本组63例中，围手术期无胆漏发生，无死亡。随访60例，随访率95．2％，随访时间0．5～10．0年，有11例术后死于肿瘤复发，其中最短的1例术后生存11个月。结论术后胆管壁的弹性回缩是胆肠吻合口狭窄的重要原因，纵行切开胆管壁扩大吻合口是预防吻合口术后狭窄简单、有效的方法。Objective To investigate/he methods and curative effects of the heavy-caliber cholangioenterostomy. Methods Sixty-three examples of heavy-caliber cholangioenterostomy which were anastomosed by the choledoch or the common hepatic duct incline plane to the intestines sidewall were analyzed retrospectively to summarize the clinical experience and lesson. Of the cases,53 were subjected to Roux-en-Y anastomosis, 10 were subjected to choledoch and duodenum anastomosis. Results There was no occurence of perioperative anastomotic leakage and death. Sixty cases were followed up for 0.5-10.0 years, the follow up rate was 95.2%, 11 cases were dead with tumor recurrence. The shortest postoperative living time was 11 months. Conclusions Retraction of the choledoch-wall is the major reason for anastomotic stricture after cholangioenterostomy, vertical open choledoch-wall and expanding of anastomotic stoma is a simple and effective method to prevent anastomotic stricture after cholangioenterostomy.

关 键 词：胆肠吻合术 吻合口狭窄 胆道感染 

分 类 号：R657.4[医药卫生—外科学]