经皮经肝硬质胆道镜下切开成形术治疗胆肠吻合口狭窄  

Stricture of choledochojejunostomy treated by percutaneous transhepatic rigid choledochoscopic incision plasty

作　　者：刘安重[1] 方天翎[1] 文辉清[1] 沈磊[1] 陈光春[1] 廖海星[2] 

机构地区：[1]广州医科大学附属第一医院微创外科中心普通外科,510230 [2]广州医科大学附属第一医院超声科,510230

出　　处：《中华实验外科杂志》2016年第10期2389-2391,共3页Chinese Journal of Experimental Surgery

基　　金：广东省科技厅省级科技计划项目（2014A020212515）

摘　　要：目的 探讨经皮经肝硬质胆道镜下切开成形术（PTCS-IP）治疗胆肠吻合口狭窄的技术方法、1年期临床疗效.方法 采用经皮经肝硬质胆道镜下针型高频电刀切开成形术治疗胆管空肠吻合口良性狭窄21例.同期经皮经肝胆道扩张成形术治疗良性胆肠吻合口狭窄10例.总结分析切开成形术组患者的病因,手术时机、技术操作特点;统计学分析该组患者胆肠吻合口狭窄环存在率、胆道感染、肝门部胆管复发结石等1年期内疗效.并与同期10例经皮经肝球囊扩张成形术患者进行比较.结果 （1）1个月后胆道镜检查证实,切开成形术组患者经电刀切开后胆肠吻合口狭窄环立即消失,残留结石可以顺利进入小肠,胆道造影显示胆肠吻合口非常通畅,第二次切开可进一步扩大吻合口,巩固疗效.而球囊扩张组中大部分胆肠吻合口扩张1个月后仍然存在明显的狭窄环.（2）经皮经肝硬质胆道镜下切开成形术组和球囊扩张术组患者出院时狭窄环存在率、1年期高热胆管炎发生率、肝门部胆管结石复发残留率分别是0.00％/80.00％、19.04％/90.00％、14.29％/90.00％（P＜0.01）.（3）因胆道穿刺置管引起的可控制的短时的胆道出血和术后胆管炎比较常见,无严重并发症.结论 采用经皮经肝硬质胆道镜下切开成形术治疗胆管空肠吻合口狭窄操作安全可靠,大部分病例1年期疗效较好,明显优于经皮经肝球囊扩张成形术组.Objective To explore the techniques,1 year clinical effects of percutaneous transhepatic rigid choledochoscopic incision plasty （PTCS-IP） in treatment of stricture of choledochojejunostomy.Methods 21 cases of percutaneous transhepatic rigid choledochoscopic high-frequency needleknife incision plasty were performed in treatment of benigh stricture of choledochojejunostomy in our hospital in 3 years.Their stricture ring;high fever cholangitis and postoperative calculi residue rate in one year period of this operation group would be observed and compared to 10 cases of the control group treated by balloon dilatation.Results （1） 1 month after 1 st incision plasty,the enlarged biliary-enteric anastomosis was observed by rigid choledochoscopy and the 2nd incision plasty was performed in order to strengthen the effects.（2） Stricture ring,high fever cholangitis,postoperative calculi residue rate in incision plasty group and in dilatation group were 0.00%/80.00%;19.04%/90.00%;14.29%/90.00%,respectively （P 〈 0.01）.（3）Only controllable hemobilia and cholangitis were the common operative complications.Conclusion Percutaneous transhepatic rigid choledochoscopic incision plasty is a safe and effective surgery procedure in treatment of stricture of choledochojejunostomy with a perfect one year period clinical effects.Further observation is needed for Long-term effects.

关 键 词：胆道镜 取石术 成形术 

分 类 号：R657.4[医药卫生—外科学]