腹腔镜胆肠Roux-en-Y吻合术在胆道再次手术中的应用分析  

Application analysis of laparoscopic Roux-en-Y cholangioenterostomy in biliary reoperation

作　　者：张成 安东均 王羊 徐垚 何进程 ZHANG Cheng;AN Dongjun;WANG Yang(Department of Hepatobiliary Surgery,the Center Hospital of Xianyang City,Xianyang 712000,China)

机构地区：[1]咸阳市中心医院西安交通大学医学部附属医院肝胆外科,陕西咸阳712000

出　　处：《腹腔镜外科杂志》2023年第10期744-748,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜Roux-en-Y胆管空肠吻合术(LRCJS)在再次胆道手术中的应用指征、操作技巧与疗效。方法:回顾分析2018年6月至2021年12月收治的首次胆肠Roux-en-Y吻合术后应用LRCJS再次行胆道手术的36例患者的临床资料。结果:首次实施Roux-en-Y胆肠吻合的原因:腹腔镜胆囊切除术中胆囊三角区严重粘连或解剖变异致胆管损伤后修复19例,肝内胆管结石术式选择不当7例,胆总管复发结石3例,Mirizzi综合征肝总管狭窄4例,胆总管囊肿2例,胆总管中段腺瘤1例。LRCJS再次手术前患者均行CT、MRCP等检查,诊断为胆肠吻合口瘢痕狭窄伴结石形成25例、肝总管狭窄伴结石4例、肝左叶胆管结石伴胆管炎7例。经术前评估内镜逆行胰胆管造影难以取出结石与纠正狭窄。25例行原胆肠吻合口拆开扩大+胆道镜取石再吻合术,4例行原胆肠吻合口拆开取石+左右肝管整形+胆肠吻合术,7例行肝左叶切除+右肝管空肠吻合术。随访6个月至4年,2例偶发右上腹疼痛、发热等急性胆管炎症状,余者均痊愈。结论:胆肠吻合术后再次行LRCJS具有痛苦少、创伤小、康复快的优势,但手术难度较大,有损伤腹腔脏器的风险,术者需具备娴熟的操作技巧。随着腹腔镜技术的发展,LRCJS已成为治疗胆道疾病再次手术的新选择。Objective:To explore the application indications,operation skills and curative effect of laparoscopic Roux-en-Y cholangiojejunostomy(LRCJS)in reoperation of biliary tract.Methods:The medical records of 36 patients who underwent second biliary tract surgery with LRCJS after the first Roux-en-Y cholangiojejunostomy from Jun.2018 to Dec.2021 were retrospectively analyzed.Results:Roux-en-Y bilioenterostomy was first performed for several reasons:in 19 cases of laparoscopic cholecystectomy,choledoenterostomy was used to repair bile duct injury caused by severe adhesion or anatomic variation of Calot triangle;the surgical method of 7 c ases of intrahepatic cholelithiasis was improper;3 cases had recurrent choledocholithiasis;4 cases of Mirizzi syndrome complicated with common hepatic duct stenosis;2 cases had choledochal cysts;One case had adenoma of the middle common bile duct.The cases inclu-ded before LRCJS reoperation were diagnosed as follows:CT/MRCP and other examinations were performed in 36 patients,and 25 cases were diagnosed as biliary-enteric anastomotic scar stenosis with stone formation;there were 4 cases of hepatic common duct stenosis complicated with calculi;left hepatic bile duct calculus with cholangitis occurred in 7 patients.Endoscopic retrograde cholangiopancrea-tography was difficult to remove stones and correct stenosis after preoperative evaluation.The specific operation methods of LRCJS r eoperation in this group were as follows:in 25 patients,the primary bilioenterostomy was opened and enlarged,and the stones were r emoved by choledochoscope and re-bilioenterostomy was performed;in 4 patients,the original bilioenteric anastomotic stoma was disa-ssembled for stone extraction+left and right hepatic duct reconstruction+bilioenteric anastomosis;left lobe resection and right hepatic duct jejunal anastomosis were performed in 7 patients.All patients were followed up for 6 months to 4 years.Two patients sometimes had acute bile duct inflammation such as right upper abdominal pain and fever,and the re

关 键 词：胆道外科手术 再手术 腹腔镜检查 胆肠吻合 吻合术 Roux-en-Y 

分 类 号：R657.4[医药卫生—外科学]