成人胆总管囊肿再次手术治疗的临床分析  

The analysis of treatment of reoperation for choledochal cyst in adult patients

作　　者：刘学谦 单深良 郭旗[1] 谢坤[1] 赵义军[1] 刘付宝[1] LIU Xue-qian;SHAN Shen-liang;GUO Qi(The First Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《肝胆外科杂志》2018年第6期443-445,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨成人胆总管囊肿术后再次手术的原因及治疗方法。方法回顾性分析2010年1月至2018年8月我院胆总管囊肿术后患者再次手术的临床资料。结果本组37例患者中,32例合并肝胆管结石,8例合并反流性胆管炎,4例胆肠吻合口狭窄,1例胆总管囊肿癌变。本次手术,胆总管囊肿切除+肝管空肠Roux-en-Y吻合术21例,9例患者因肝内胆管结石联合肝叶切除,4例行胆肠吻合口拆除重建; 4例行胆汁袢重建,1例胆总管囊肿癌变无法切除仅行肿瘤活检。患者均痊愈出院,无死亡病例。随访中2例患者结石复发再次手术。结论胆总管囊肿术式选择不当及术后相关并发症为再次手术的主要原因,合理的手术方式及个体化治疗是减少胆总管囊肿术后再次手术的关键。Objective To investigate the reasons and treatment of reoperation for choledochal cyst in adult patients.Methods The clinical data of patients undergoing reoperation after choledochal cyst surgery in our hospital from January 2010 to August 2018 were analyzed retrospectively.Results Among the 37 patients,32 presented bile duct stones,8 suffered from reflux cholangitis,4 had strictures of hepatojejunal anastomosis,1 had carcinoma arising in cyst.In this operation,Cyst excision with Roux-en-Y hepatieojejunostomy were conducted in 21 patients,9 patients were treated with hepatectomy on account of intrahepatic calculus,4 patients were treated with hepatojejunal anastomosis reconstruction.Biliary jejunal loop reconstruction was performed in 4 patients,and tumor biopsy was performed in 1 patient with unresectable tumor arising in cyst.All the patients were cured and discharged without any death.During the follow-up,two patients accepted second operation due to recurrence of calculus.Conclusion Improper choice of surgical procedure for choledochal cyst and postoperative complications are the main reasons for reoperation.Reasonable surgical method and individualized treatment are the key to reduce the reoperation of choledochal cyst after surgery.

关 键 词：胆总管囊肿 再次手术 吻合口狭窄 

分 类 号：R657.4[医药卫生—外科学]