保留Oddi括约肌功能的空肠盲段肝胆管盆成型术在肝内胆管结石治疗中的应用  

Blind jejunum segment hepaticoplasty in treating intrahepatic lithiasis.

作　　者：徐智[1] 邓绍庆[1] 张能维[1] 韦佳明 陆少美[1] 周孝思[1] 

机构地区：[1]北京医科大学第三医院外科

出　　处：《中国实用外科杂志》1998年第2期79-82,共4页Chinese Journal of Practical Surgery

摘　　要：为解决肝内胆管结石行胆肠吻合术后抗返流和引流的矛盾，采用游离空肠盲段代替Ｙ型空肠与肝胆管盆吻合以修复肝胆管盆前壁的缺损，从而保留Ｏｄｄｉ括约肌的结构和功能并将盲端埋置皮下。近５年共完成２１例，随访１～５年。残石４例，１例自行排出，３例引起胆管炎复发，均经空肠皮下盲端胆道镜取石并引流治愈。胆管炎复发率１４３％，较肝胆管盆空肠Ｙ型吻合术者（３５％）低。胃肠造影见Ｏｄｄｉ括约肌能防止肠胆返流。胆道造影和同位素肝胆扫描见游离空肠段有推动胆汁和残石排出胆道的泵样作用，胆道排空时间比术前明显缩短。胆汁细菌培养术后与术中无显著差异。与胆色素结石形成有关的各种胆汁成分术后都较术前含量低，虽然除总钙量外差异均无显著性，但此趋势有利于防石而不是成石。Abstract In order to avoid the intestino biliary reflux,a blind jejunum segment instead of Y shape jejunum was used to repair the defect on the anterior wall of biliary duct after the formation of hepaticobiliary basin.The efferent end was anastomosed to the hepaticobiliary basin;the afferent end was closed and fixed subcutaneously.Therefore,the structure and function of the sphincter of Oddi was preserved.During the recent 5 years,21 patients had been treated with this procedure and have been followed up for 1 to 5 years.Residual stones were identified in 4 patients;in 3 of them,impaction of stones in the common bile duct caused a mild cholangitis.The patients recovered after removal of the stones via the subcutaneous blind end of jejunum.The recurrent rate of cholangitis is 14 3%,whereas that of Roux en Y hepatico jejunostomy is 35%.No reflux through the sphincter of Oddi was revealed during upper gastrointestinal X ray studies.Postoperative cholangiography indicated that the peristalsis of the blind jejunum segment was active and regular.Hepatobiliary radionuclide scans suggested that the time to clean the nuclide out from hepatobiliary system into duodenum in postoperative period was shorter than that in pre operative period(P<0 05).The differences of bacterial culture and the components related to pigment gallstone formatio] 74 )

关 键 词：肝内胆管结石 胆肠吻合 ODDI括约肌 胆管结石 

分 类 号：R657.420.5[医药卫生—外科学]