皮下预置盲襻型胆肠吻合术治疗成人先天性胆管扩张症  

Subcutaneously preplaced blind-collar bile-intestinal anastomosis for adult congenital biliary dilatation

作　　者：吕小飞 赵舸[2] Lyu Xiaofei;Zhao Ge(Shanxi Medical University,Taiyuan 030000,China;Department of General Surgery,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,太原030000 [2]山西医科大学第二医院普外科,太原030001

出　　处：《中华普通外科学文献（电子版）》2024年第4期258-261,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的通过研究皮下预置盲襻型Roux-en-Y胆肠吻合术治疗成人先天性胆管扩张症(CBD)的优势,为成人CBD提供一种可靠且受益多的手术方式。方法收集并回顾性分析山西医科大学第二医院1985年1月至2024年1月收治的16例因CBD行皮下预置盲襻型Roux-en-Y胆肠吻合术患者资料,年龄(32.75±7.51)岁。通过分析手术时间、术中出血量、术后并发症、术后住院时间以及术后长期并发症的处理等,评估皮下预置盲襻型Roux-en-Y胆肠吻合术治疗成人CBD的疗效及可行性。结果16例患者手术成功率为100.0%,均未出现严重的术中并发症。其中开腹手术8例,平均手术时间为(186.13±14.12)min,术中平均出血量为(30.63±7.29)ml,术后平均住院时间为(8.50±1.31)d;腹腔镜手术8例,平均手术时间为(251.50±14.68)min,术中平均出血量为(25.63±4.96)ml,术后平均住院时间为(5.75±0.46)d。术后均未出现切口感染、出血、吻合口狭窄、胆管炎、肠瘘、肠梗阻、胰漏、胰腺炎等并发症。6例因结石复发,在局麻下打开盲襻,胆道镜取石成功,一期缝合手术切口,愈合良好,手术创伤小,患者满意度较高。结论皮下预置盲襻型Roux-en-Y胆肠吻合术可以简单方便、安全有效地处理多种成人CBD术后并发症,避免了二次腹腔手术,值得推广。Objective To provide a reliable and beneficial surgical procedure for adult congenital biliary dilatation(CBD)by investigating the advantages of subcutaneously preplaced blind-collar Roux-en-Y bile-intestinal anastomosis for the treatment of adult CBD.Methods 16 patients,with the age of(32.75±7.51)years old,who were subcutaneously preplaced blind-collar Roux-en-Y bile-intestinal anastomosis for CBD admitted to the Second Hospital of Shanxi Medical University from January 1985 to January 2024 were collected and analyzed retrospectively.The efficacy and feasibility of subcutaneously preplaced blind-collared Roux-en-Y bile-intestinal anastomosis for the treatment of CBD were evaluated by observing the duration of the operation,intraoperative bleeding,postoperative complications,postoperative hospitalization days,and by discussing the management of long-term postoperative complications.Results The surgical success rate of 16 patients was 100.0%,and none of them had serious intraoperative complications.Among them,there were 8 cases of open surgery and 8 cases of laparoscopic surgery,with an average operating time of(32.75±7.51)minutes and(251.50±14.68)minutes,the average intraoperative blood loss were(30.63±7.29)ml and(25.63±4.96)ml,and the average postoperative hospital stay were(8.50±1.31)days and(5.75±0.46)days,respectively.None of them suffered from incisional infections,hemorrhage,anastomotic stenosis,biliary tract infection,intestinal fistula,intestinal obstruction,pancreatic leakage,and intestinal fistula after the operation.In 6 patients,due to stone recurrence,the blind collaterals were reopened under local anesthesia,and choledochoscopic stone extraction was successful.After stone extraction,the surgical incision was closed in one stage,and the postoperative incision healed well with little surgical trauma and high patient satisfaction.Conclusion Subcutaneously preplaced blind-collar Roux-en-Y bile-intestinal anastomosis can be simple and convenient to deal with a variety of postoperative complication

关 键 词：先天性胆管扩张症 胆总管疾病 吻合术 Roux-en-Y 皮下盲襻 并发症 

分 类 号：R657.4[医药卫生—外科学]