经皮球囊扩张联合引流管支撑治疗胆总管囊肿切除术后胆肠吻合口狭窄  

Effect of percutaneous balloon dilatation combined with drainage tube stenting for biliaryenteric anastomotic stricture after choledochal cyst resection

作　　者：张坤 林美举[1] 马跃峰[1] 张洪威[1] 常宏亮 王向男 ZHANG Kun;LIN Meiju;MA Yuefeng;ZHANG Hongwei;CHANG Hongliang;WANG Xiangnan(Department of Minimally Invasive Cholelithiasis,Zhongshan Hospital Affiliated to Dalian University,Dalian,Liaoning 116001,China)

机构地区：[1]大连大学附属中山医院胆石病微创外科,辽宁大连116001

出　　处：《肝胆胰外科杂志》2024年第8期459-462,467,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：登峰计划医学重点专科建设项目(2021243)。

摘　　要：目的 探讨经皮球囊扩张联合引流管支撑治疗胆总管囊肿切除术后胆肠吻合口狭窄的临床价值。方法 回顾性分析2018年2月至2023年6月大连大学附属中山医院采取经皮球囊扩张联合引流管支撑治疗的6例胆总管囊肿切除术后胆肠吻合口狭窄患者的临床资料。观察患者术后临床症状及肝功能的改善情况,胆道镜检查评估患者吻合口狭窄情况。结果 6例患者均成功实施经皮肝穿刺胆管引流及瘘道扩张术,镜下诊断为单纯性吻合口狭窄4例,吻合口狭窄合并肝内胆管结石2例。2例肝内胆管结石经多次胆道镜手术取净。6例患者均成功实施狭窄胆肠吻合口球囊扩张术,外引流管支撑胆肠吻合口6~7个月后拔除。胆道镜检查发现吻合口黏膜正常5例;吻合口黏膜水肿伴相对狭窄1例,经继续置入引流管支撑3个月后拔除。术后随访10~74个月,均无吻合口狭窄复发。结论 经皮球囊扩张联合引流管支撑是治疗胆总管囊肿切除术后胆肠吻合口狭窄的一种微创、有效的治疗方法,且并发症发生率较低。objective To explore the clinical value of percutaneous balloon dilatation combined with drainage tube stenting for biliary-enteric anastomotic stricture after choledochal cyst resection.Methods A retrospective analysis was conducted on the clinical data of 6 patients with biliary-enteric anastomotic stricture after choledochal cyst resection,who admitted in Zhongshan Hospital Affiliated to Dalian University between Feb.2018 and Jun.2023,and then received percutaneous balloon dilatation combined with drainage tube stenting.The postoperative clinical symptoms and liver function were observed,and the cholangioscopy examination was used to assess the stricture at the anastomotic site.Results All the 6 patients underwent percutaneous transhepatic cholangial drainage and fistula dilatation successfully.Endoscopy examination identified 4 cases of simple anastomotic stricture,2 cases of anastomotic stricture complicated with intrahepatic bile duct stones,and the intrahepatic bile duct stones in 2 cases were cleared by multiple endoscopy operations.Balloon dilatation of the strictured biliary-enteric anastomosis was successfully performed in all 6 patients,with external drainage tube removed after 6-7 months.Cholangioscopy examination revealed normal mucosa in 5 cases and mucosal edema with relative stricture in 1 case,who was warranted further drainage tube support for additional 3 months.Follow-up periods ranged from 10 to 74 months,with no case of anastomotic stricture recurrence.Conclusion For biliary-enteric anastomotic stricture after choledochal cyst resection,percutaneous balloon dilatation combined with drainage tube stenting is a minimally invasive and effective treatment method,with low postoperative complication rate.

关 键 词：先天性胆总管囊肿 胆肠吻合口狭窄 经皮肝穿刺胆管引流 球囊扩张 胆道镜 

分 类 号：R657.4[医药卫生—外科学]