先天性胆总管囊肿切除及胆道重建  

BILIARY TRACT RECONSTRUCTION AFTER CYSTECTOMY OF CONGENITAL CHOLEDOCHAL CYST

作　　者：胡廷泽[1] 吴学东[1] 刘文英[1] 郎诗民[1] 李福玉[1] 蒋小平[1] 钟麟[1] 冯杰雄[1] 李园[1] 

机构地区：[1]华西医科大学附属第一医院小儿外科

出　　处：《中国修复重建外科杂志》2001年第3期165-167,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　评价先天性胆总管囊肿切除胆道重建的术式。方法　对 1984年 7月～ 1999年 12月行囊肿切除胆道重建的 10 6例先天性胆总管囊肿进行随访复查。胆道重建包括单纯 Roux- Y吻合 48例、Roux- Y吻合套叠瓣成形 37例和 Roux- Y吻合矩形瓣成形 2 1例。结果　获随访 5 9例 ,随访时间平均 4.6 8年。术中加作抗返流措施者无一例发生返流性胆管炎 ,未作抗返流瓣者术后发生逆行性胆道感染 3例 ,2例再次行套叠瓣成形后症状消失。结论　规范性的彻底切除病变囊壁组织、有效的空肠袢肝总管 Roux- Y吻合加套叠瓣成形 ,可有效的防止术后逆行感染。Objective To evaluate the operative methods of biliary tract reconstruction after cystectomy of congenital choledochal cyst(CCC). Methods One hundred and six cases with CCC underwent cystectomy and biliary tract reconstruction in our hospital from July 1984 to December 1999 were followed up. Among them, there were three kinds of procedures in biliary tract reconstruction: with single Roux Y hepaticojejunostomy in 48 cases, with intussusceptive valve to the line of Roux Y hepaticojejunostomy in 37 cases, with rectangular valve to the line of Roux Y hepaticojejunostomy in 21 cases. Results Fifty nine cases were followed up for 4.68 years in average. There were 3 cases with ascending cholangitis after single Roux Y hepaticojejunostomy. And the symptom disappeared in 2 cases underwent reoperation with an intussueceptive valve plasty to the line of Roux Y hepaticojejunostomy. No patients suffered from ascending cholangitis in the precautionary valve plasty group. Conclusion It suggests that the postoperative ascending cholangitis can be prevented effectively if standard cystectomy and prophylactic intussusceptive valve added to the line of Roux Y hepaticojejunostomy are carried out. The procedure should be performed as soon as possible providing the child is tolerable.

关 键 词：先天性胆总管囊肿 胆道重建 套叠瓣 

分 类 号：R657.4[医药卫生—外科学]