经皮空肠引流术治疗胆肠吻合术后肝内胆管结石的效果评价  

Efficacy of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy

作　　者：张诚 杨玉龙 何川琦 崔峥[2] 梁婷[2] 林慧 Zhang Cheng;Yang Yulong;He Chuanqi;Cui Zheng;Liang Ting;Lin Hui(不详;Department of Ultrasound Intervention,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院胆石病中心(同济大学医学院胆石病研究所),上海200120 [2]同济大学附属东方医院超声介入科,上海200120

出　　处：《中华肝胆外科杂志》2022年第10期747-750,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：浦东新区临床特色学科基金(PWYts2021-06)。

摘　　要：目的:探讨经皮空肠引流术治疗胆肠吻合术后肝内胆管结石的可行性和安全性。方法:回顾性分析2021年5月至2022年5月于同济大学附属东方医院胆石病中心采用经皮空肠引流术治疗的24例胆肠吻合术后肝内胆管结石患者的临床资料,其中男性16例,女性8例,年龄(50.46±10.89)岁,年龄范围28~68岁。对胆肠吻合术后诊断为肝内胆管结石患者,局麻下行超声及X线引导下经皮空肠造影术,成功后直接扩张瘘道并留置16.0Fr引流管,3 d后实施经皮经空肠胆道镜,统计操作成功率、并发症发生率及结石取净率等。结果:24例患者行经皮空肠造影术治疗,成功率79.2%(19/24),其中结肠前胆肠吻合19例,成功率94.7%(18/19),结肠后胆肠吻合5例,成功率20.0%(1/5),未发生出血、肠漏、胆漏等并发症。19例经皮空肠造影术成功者,瘘道扩张成功率100%(19/19),无并发症;5例经皮空肠造影术失败者,行开腹经胆肠吻合空肠襻胆道探查取石术,术后发生胆漏1例。24例行胆道镜检查及选择性胆道造影,诊断为吻合口狭窄13例、肝内胆管狭窄5例、吻合口并肝内胆管狭窄6例;经胆道镜下电切、柱形球囊扩张、取石、支架支撑等治疗,狭窄解除率100%(24/24),肝内胆管结石取净率91.7%(22/24)。结论:经皮空肠引流术是治疗胆肠吻合术后肝内胆管结石的一种安全、可行的方法,尤其适用于结肠前胆肠吻合患者。Objective To study the feasibility and safety of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy.Methods The clinical data of 24 patients with hepatolithiasis after choledochojejunostomy treated by percutaneous jejunal drainage at the Cholelithiasis Center,Shanghai East Hospital Affiliated to Tongji University from May 2021 to May 2022 were retrospectively analyzed.There were 16 males and 8 females,aged(50.46±10.89)years old.Ultrasound and X ray guided percutaneous jejunography was performed under local anesthesia for patients with hepatolithiasis after choledochojejunostomy.Then the fistula was directly dilated to 16.0Fr,and percutaneous jejunal choledochoscopy was performed 3 days later.The success rate,complication rate and stone removal rate were analysed.Results Twenty-four patients were treated with percutaneous jejunography,with a success rate of 79.2%(19/24),including 19 patients after anterior colonic cholangiojejunostomy with a success rate of 94.7%(18/19),and 5 patients after retrocolonic cholangiojejunostomy with a success rate of 20.0%(1/5).There was no complication including bleeding,intestinal leakage and bile leakage.In 19 patients with successful percutaneous jejunography,the success rate of fistula dilation was 100%(19/19),and there was no complication.Five patients with failed percutaneous jejunography underwent open choledocholithotomy through the jejunal output-loop,and bile leakage occurred in one patient.Thirteen patients with anastomotic stenosis,5 with intrahepatic biliary strictures,and 6 with anastomotic and intrahepatic biliary strictures were diagnosed by choledochoscopy and selective cholangiography in these 24 patients.After choledochoscopic electrotomy,cylindrical balloon dilation,stone removal,stenting and other treatments,the stenosis relief rate was 100%(24/24),and the clearance rate of intrahepatic bile duct stones was 91.7%(22/24).Conclusion Percutaneous jejunal drainage was a feasible,safe and minimally invasive method for treatment

关 键 词：胆总管囊肿 胆结石 胆管肠吻合术 肝 超声介入 

分 类 号：R657.42[医药卫生—外科学]