摘要
目的探讨胆管空肠Roux-en-Y吻合联合腹膜下空肠盲袢固定标记法在肝胆管结石病术后及其伴随的胆管狭窄治疗中的价值。方法回顾性分析2009年1月至2017年12月在北京大学第一医院接受胆管空肠Roux-en-Y吻合联合腹膜下空肠盲袢固定标记术的113例肝胆管结石病病人的临床资料。并对术后经肠袢胆道镜治疗肝内胆管结石和狭窄的情况进行总结。结果 113例病人全部完成胆肠吻合及盲袢固定标记术并在术后行胆道镜检查,其中79例行胆道镜取石治疗;49例行胆道镜下球囊扩张肝内胆管狭窄,7例发现有术后近期吻合口狭窄而行球囊扩张,71例证实结石取净或狭窄缓解后结束治疗。16例在治疗结束后因肝内胆管结石复发而在局麻下打开空肠盲袢,其中15例顺利完成再次治疗。结论空肠盲袢固定标记法便于在胆管空肠Roux-en-Y吻合后进一步治疗肝内胆管结石及狭窄,并使多数复发病例避免了再次开放手术,对于易复发的肝胆管结石病是一种可供选择的治疗方法。
ObjectiveTo investigate the value of Roux-en-Y cholangiojejunostomy combined with marked fixation of jejunal loop in the treatment of hepatolithiasis and biliary stricture.Methods The clinical data of 113 patients with hepatolithiasis who received Roux-en-Y cholangiojejunostomy combined with marked subperitoneal fixation of blind jejunual loop in Peking University First Hospital from January 2009 to December 2017 were analyzed retrospectively.Meanwhile,the treatment of hepatolithiasis and biliary stricture by postoperative choledochoscopy via intestinal loop was summarized.ResultsAll of 113 patients underwent choledochojejunostomy and blind loop fixation,and subsequent choledochoscopy;79 of them needed to clear the residual intrahepatic stones;49 of them needed balloon dilatation for biliary strictures;7 of them were found to have early postoperative anastomotic stenosis and needed balloon dilatation,and the treatment was ended in 71 of them after stone removal and stricture relief. In 16 cases,the blind loop of jejunum was opened again under local anesthesia due to the recurrence of intrahepatic cholelithiasis after treatment,and the choledochoscopy was successfully completed again in 15 of them.ConclusionThe method of blind jejunal loop fixation is convenient for subsequent treatment of residual intrahepatic stones and strictures after Roux-en-Y cholangiojejunostomy,and it can avoid reoperation in most recurrent cases,which is a choice for the treatment of recurrent hepatolithiasis.
作者
边大鹏
史继荣
田孝东
张寰
杨尹默
冯秋实
BIAN Da-peng;SHI Ji-rong;TIAN Xiao-dong(Department of Hepatobiliary Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第6期715-718,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金项目(No.81871954)。
关键词
肝胆管结石病
胆肠吻合术
空肠盲袢
胆道镜
hepatolithiasis
choledochojejunostomy
blind jejunal loop
choledochoscopy
