胆管空肠Roux-en-Y吻合术后再手术原因及对策  

Causes and Measures of Reoperation after Roux-en-Y Choledochojejunostomy

作　　者：王成[1] 黄强[1] 朱英淮 

机构地区：[1]安徽省立医院肝胆外科,合肥230001 [2]安徽省淮南市谢一矿医院,淮南232000

出　　处：《中国现代手术学杂志》2001年第2期105-106,共2页Chinese Journal of Modern Operative Surgery

摘　　要：目的　探讨胆管空肠Roux en Y吻合术 (胆肠R Y吻合术 )后再手术的原因及对策。　方法　对我院1988年 1月至 1999年 10月收治的 2 0例胆肠R Y吻合术后再手术病人的临床资料作回顾性分析。　结果　再手术原因有 :肝内胆管狭窄伴结石 4例 ;肝门胆管狭窄伴结石 6例 ;吻合口狭窄伴结石 4例 ;单纯吻合口狭窄 3例 ;反流性胆管炎 2例 ;胆管末端漏斗综合征 1例。再手术方式 :吻合口切开整形并左肝外叶切除 2例 ;肝门胆管切开整形 ,取尽结石后行高位胆管空肠再吻合 7例 ;原吻合口扩大整形 ,取石 8例 ;吻合口切开整形 ,桥袢延长并人工空肠套叠 1例 ;经空肠盲袢取石 ,吻合口扩大成形 1例 ;吻合口切除 ,胆肠端侧吻合 ,胆总管盲端关闭 1例。全组病人经治疗后均痊愈出院。　结论　胆肠R Y吻合术及以后的再手术均应以取尽结石 ,纠正狭窄 ,去除病灶 ,通畅引流为原则 ,方可提高疗效 。Objective To discuss the causes and measures of reoperation after Roux en Y choledochojejunostomy. Methods 20 patients underwent reoperations after Roux en Y choledochojejunostomy from 1988.1 to 1999.10 were analyzed.Results The causes of reoperation were as follows: intrahepatic biliary stricture with stones in 4 cases, porta hepatis bile duct stricture with stones in 6 cases, anastomotic stoma stricture with stones in 4 cases, simple anastomotic stoma stricture in 3 cases, reflux cholangitis in 2 cases, funnel syndrome in 1 case. The measures of reoperation were as follows: opening of the anastomotic stoma and resection of the left lateral lobe of the liver in 2 cases; choledochojejunostomy after opening of the hilar bile duct with orthoplasty and extraction of the stones in 7 cases, expanding of the primary anastomotic stoma and extraction of the stones in 8 cases, opening of the anastomotic stoma and lengthening of the ascending jejunal pontoon with a factitious intersuscception on it in 1 case, extraction of the stones and expanding of the anastomotic stoma through the blind jejunal loop in 1 case, dissection of the original anastomotic stoma and made a new end side choledochojejunostomy with closing of the lower blind end of the common duct in 1 case. All the patients were discharged in good condition. Conclusion It is suggested that complete extration of the stones, correction of the stricuture, removal of the unsound tissue and establishment of a free drainage are the key points to the enhancement of the surgical effects and the reduction of the reoperation rate in Roux en Y choledochojejunostomy or the second time operation.

关 键 词：再手术 胆道外科 胆管空肠ROUX-EN-Y吻合术 内引流术式 

分 类 号：R657.4[医药卫生—外科学]