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Pneumobilia,chronic diarrhea,vitamin K malabsorption:A pathognomonic triad for cholecystocolonic fistulas 被引量:21
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作者 Savvoula Savvidou John Goulis +1 位作者 Alexandra Gantzarou George Ilonidis 《World Journal of Gastroenterology》 SCIE CAS CSCD 2009年第32期4077-4082,共6页
Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree d... Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF. 展开更多
关键词 Cholecystocolonic fistula Cholecystocolonicfistula bilioenteric fistula PNEUMOBILIA
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Bilioenteric anastomotic stricture in patients with benign and malignant tumors: prevalence,risk factors and treatment 被引量:5
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作者 Ji-Qiao Zhu Xian-Liang Li +5 位作者 Jian-Tao Kou Hong-Meng Dong Huan-Ye Liu Chun Bai Jun Ma Qiang He 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2017年第4期412-417,共6页
BACKGROUND: Stricture formation at the bilioenteric anastomosis is a rare but important postoperative complication. However, information on this complication is lacking in the literature. In the present study, we aime... BACKGROUND: Stricture formation at the bilioenteric anastomosis is a rare but important postoperative complication. However, information on this complication is lacking in the literature. In the present study, we aimed to assess its prevalence and predictive factors, and report our experience in managing bilioenteric anastomotic strictures over a ten-year period. METHODS: A total of 420 patients who had undergone bilioenteric anastomosis due to benign or malignant tumors between February 2001 and December 2011 were retrospectively reviewed. Univariate and multivariate modalities were used to identify predictive factors for anastomotic stricture occurrence. Furthermore, the treatment of anastomotic stricture was analyzed. RESULTS: Twenty-one patients (5.0%) were diagnosed with bilioenteric anastomotic stricture. There were 12 males and 9 females with a mean age of 61.6 years. The median time after operation to anastomotic stricture was 13.6 months (range, 1 month to 5 years). Multivariate analysis identified that surgeon volume (<30 cases) (odds ratio:-1.860; P=0.044) was associated with the anastomotic stricture while bile duct size (>6 mm) (odds ratio: 2.871; P=0.0002) had a negative association. Balloon dilation was performed in 18 patients, biliary stenting in 6 patients, and reoperation in 4 patients. Five patients died of tumor recurrence, and one of heart disease. CONCLUSIONS: Bilioenteric anastomotic stricture is an uncommon complication that can be treated primarily by interventional procedures. Bilioenteric anastomosis may be performed by a surgeon in his earlier training period under the guidance of an experienced surgeon. Bile duct size >6 mm may play a protective role. 展开更多
关键词 anastomotic stricture bilioenteric anastomosis bile duct size surgeon volume
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Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration 被引量:2
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作者 Wen-Guang Wu Lu-Cui Qin +9 位作者 Xiao-Ling Song Ming-Ning Zhao Wen-Jie Zhang Jun Gu Hao Weng Ying-Bin Liu Yi Zhang Chun-Ying Qu Lei-Ming Xu Xue-Feng Wang 《World Journal of Gastroenterology》 SCIE CAS 2019年第36期5505-5514,共10页
BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challengi... BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate. 展开更多
关键词 bilioenteric ROUX-EN-Y ANASTOMOSIS Single balloon ENTEROSCOPY Multidisciplinary cooperation HEPATICOJEJUNOSTOMY PANCREATICODUODENECTOMY
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Dilation of a severe bilioenteric or pancreatoenteric anastomotic stricture using a Soehendra Stent Retriever 被引量:1
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作者 Koichiro Tsutsumi Hironari Kato +6 位作者 Ichiro Sakakihara Naoki Yamamoto Yasuhiro Noma Shigeru Horiguchi Ryo Harada Hiroyuki Okada Kazuhide Yamamoto 《World Journal of Gastrointestinal Endoscopy》 CAS 2013年第8期412-416,共5页
Bilioenteric or pancreatoenteric anastomotic stric-tures often occur after surgery for a pancreaticobiliary disorder. Therapeutic endoscopic retrograde cholan-giopancreatography using balloon enteroscopy has been show... Bilioenteric or pancreatoenteric anastomotic stric-tures often occur after surgery for a pancreaticobiliary disorder. Therapeutic endoscopic retrograde cholan-giopancreatography using balloon enteroscopy has been shown to be feasible and effective in patients with such strictures. However, when a benign anas-tomotic stricture is severe, a dilation catheter cannot pass through the stricture despite successful insertion of the guidewire. We report on the usefulness of the Soehendra Stent Retriever over a guidewire for dilating a severe bilioenteric or pancreatoenteric anastomotic stricture under short double-balloon enteroscopy, in two patients with surgically altered anatomies. 展开更多
关键词 bilioenteric anastomotic STRICTURE Soehen-dra STENT Retriever DILATION Pancreatoenteric anasto-motic STRICTURE Double-balloon ENTEROSCOPY
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A New Surgical Technique of Biliary Drainage
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作者 Shafiqul Hoque 《International Journal of Clinical Medicine》 2013年第9期400-404,共5页
Introduction: Roux-en-Y Hepatico-jejunostomy is the standard technique of biliary reconstruction after excision of choledochal cyst. Here the author describes a new surgical technique of biliary reconstruction using n... Introduction: Roux-en-Y Hepatico-jejunostomy is the standard technique of biliary reconstruction after excision of choledochal cyst. Here the author describes a new surgical technique of biliary reconstruction using native gall bladder as biliary conduit. New Surgical Technique: The choledochal cyst is excised as standard technique but gall bladder with its neck is kept in situ. The gall bladder neck is anastomosed with the common hepatic duct stump and gall bladder fundus is anastomosed with the antero-inferior wall of the first part of distal duodenum. Materials & Methods: Eleven patients with choledochal cyst have been operated with the new technique from July 2011 to December 2012 in the city of Dhaka, Bangladesh. Feeding was started from 3rd post-operative day and drain was removed by 7th day unless complicated and they were released from the hospital between 10-15 days. Results: The ages of eleven patients were from 3 months to 11 years. There were 7 females and 4 males. Lump was felt in 3 patients and jaundice was present in 4 patients. Recurrent abdominal pain was present in all patients. They were diagnosed by ultrasonography and MRCP was done in 6 patients only. Prothrombin time was elevated by 10% & 15% in 2 patients. Average operation time was 2 hours and 10 minutes. A 9-year girl died suddenly and unexpectedly on the 5th post-operative day from severe convulsion of unknown origin. One child suffered from prolonged bile leakage and re-explored to repair anastomotic leak. Another patient had a collection near the anastomosis which resolved spontaneously. Discussion: Benefits of the new surgical technique are total absence of Roux-en-Y related intestinal complications. Possible disadvantages are discussed. It is anatomical and physiological. Small incision and less operation time are other benefits which need to be mentioned. Possible disadvantages are discussed. 展开更多
关键词 BILIARY RECONSTRUCTION bilioenteric ANASTOMOSIS Choledocho-Cholecystostomy Cholecysto-Duodenostomy Choledocho-Cholecysto-Duodenostomy
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Application of a new-type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute bile duct injury in dogs
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作者 Jianhui Li Yi Lü Bo Qu Zhiyong Zhang Chang Liu Yuan Shi Bo Wang Xuewen Ji Liang Yu 《Journal of Nanjing Medical University》 2007年第3期151-154,共4页
Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation a... Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute bile duct injury in dogs ). Methods: Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results: The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion: It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs. 展开更多
关键词 magnet stent bile duct injury bilioenteric anastomosis RECONSTRUCTION
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Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?
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作者 Paulo Herman Marcos V Perini +5 位作者 Vincenzo Pugliese Julio Cesar Pereira Marcel Autran C Machado William A Saad Luiz AC D'Albuquerque Ivan Cecconello 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第27期3423-3426,共4页
AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed... AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct(>2 cm).Late results and risk factors for recurrence of symptoms or stones were evaluated.RESULTS:There was no operative mortality.After a mean follow-up of 50.3 mo,good late results were observed in 82.9% of patients;all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms(P=0.0006).Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%,respectively(P<0.001).CONCLUSION:Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution.Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct. 展开更多
关键词 Biliary lithiasis bilioenteric anastomosis CHOLANGITIS Intrahepatic lithiasis Liver resection
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不能切除的胆管癌的胆道引流术(附80例临床分析) 被引量:26
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作者 殷晓煜 梁力建 《中国实用外科杂志》 CSCD 北大核心 1998年第6期343-345,共3页
目的:了解胆道引流治疗不能切除的胆管癌的治疗效果。方法:分析经胆道引流手术治疗的不能切除的胆管癌80例的临床资料及生存情况,其中肝门部胆管癌49例(61.3%),胆总管中上段癌9例(11.2%),胆总管下段癌22例(27.5%).手术... 目的:了解胆道引流治疗不能切除的胆管癌的治疗效果。方法:分析经胆道引流手术治疗的不能切除的胆管癌80例的临床资料及生存情况,其中肝门部胆管癌49例(61.3%),胆总管中上段癌9例(11.2%),胆总管下段癌22例(27.5%).手术方式包括胆肠吻合的内引流术,U或T管外引流,或两者联用。结果:15%的病例术后早期出现并发症,手术死亡率为10%。术后随访:肝门部胆管癌、胆总管中上段癌及胆总管下段癌中位生存期分别为6.10、5.50和9.50个月。胆总管中上段癌无1年以上生存者,肝门部胆管癌和胆总管下段癌1、2、3年生存率分别为27.39%、38.54%,6.59%、8.97%和2.10%、0。结论:胆道引流手术是治疗不能切除胆管癌的一种重要方法,可获良好的姑息治疗效果。 展开更多
关键词 胆管肿瘤 胆道引流 姑息疗法
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快速康复外科理念在胆肠吻合术中的临床应用效果分析 被引量:18
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作者 王建国 高静涛 +3 位作者 李庆怀 秦建伟 王惠民 邵晓莉 《肝胆胰外科杂志》 CAS 2012年第2期103-105,109,共4页
目的探讨快速康复外科(FTS)理念在胆肠吻合术中应用的临床效果。方法选择72例经评估可耐受并必须实施胆肠吻合术的患者,随机实施分组,即FTS组(n=36)和对照组(n=36),比较两组麻醉苏醒时间、术后离床活动时间、通气时间、住院天数及住院... 目的探讨快速康复外科(FTS)理念在胆肠吻合术中应用的临床效果。方法选择72例经评估可耐受并必须实施胆肠吻合术的患者,随机实施分组,即FTS组(n=36)和对照组(n=36),比较两组麻醉苏醒时间、术后离床活动时间、通气时间、住院天数及住院费用、术后并发症的差别。结果快速康复外科组术后麻醉苏醒时间、术后离床活动时间、通气时间、住院天数及住院费用显著降低(P<0.01),两组麻醉苏醒时间比较差异无统计学意义(P>0.05)。结论快速康复外科理念对胆肠吻合手术有较好的临床应用价值,可明显加快患者的康复速度,缩短住院日程,节省同类手术的住院费用。 展开更多
关键词 快速康复外科 胆肠吻合 临床应用
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Oddi括约肌松弛是肝胆管结石病中应重视的问题 被引量:16
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作者 梁廷波 白雪莉 粟伟 《中华消化外科杂志》 CAS CSCD 北大核心 2017年第4期359-362,共4页
肝胆管结石病目前仍是我国常见和多发的胆道疾病,其发病机制不明确,长期疗效欠佳。手术是唯一可能根治肝胆管结石病的手段,但术后复发率高,再次和多次手术仍然困惑着医师和患者。相关的胆管炎、肝脓肿、肝硬化及胆管细胞癌问题反映... 肝胆管结石病目前仍是我国常见和多发的胆道疾病,其发病机制不明确,长期疗效欠佳。手术是唯一可能根治肝胆管结石病的手段,但术后复发率高,再次和多次手术仍然困惑着医师和患者。相关的胆管炎、肝脓肿、肝硬化及胆管细胞癌问题反映了该疾病的危害性。Oddi括约肌在控制胆汁排放、防止肠内容反流上作用关键。Oddi括约肌功能障碍与胆道疾病关系密切,这包括Oddi括约肌的痉挛、狭窄和松弛。松弛的Oddi括约肌可加剧胆肠反流,诱发胆道感染,导致结石发生和发展。近年来该问题越来越得到广大学者的重视。但如何评估和恢复异常的Oddi括约肌功能,以治疗和防止肝胆管结石的复发仍有许多未知。 展开更多
关键词 肝胆管结石病 ODDI括约肌 胆肠反流 胆肠内引流术
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加速康复外科在营养不良肝胆管结石病胆肠吻合术中的应用价值 被引量:13
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作者 李民 汪岩 +6 位作者 张陈 孙平 程翔 李潼 宋自芳 张勇 郑启昌 《中华消化外科杂志》 CAS CSCD 北大核心 2016年第1期42-46,共5页
目的探讨加速康复外科(ERAS)在营养不良肝胆管结石病患者胆肠吻合术中的应用价值。方法选取2013年7月至2015年2月华中科技大学同济医学院附属协和医院收治的60例营养不良肝胆管结石病患者进行前瞻性研究。采用随机对照研究,通过随机... 目的探讨加速康复外科(ERAS)在营养不良肝胆管结石病患者胆肠吻合术中的应用价值。方法选取2013年7月至2015年2月华中科技大学同济医学院附属协和医院收治的60例营养不良肝胆管结石病患者进行前瞻性研究。采用随机对照研究,通过随机数字表法将入组患者分为ERAS组和对照组。ERAS组采用ERAS围术期处理方案,对照组采用传统围术期处理方案。两组患者消化道重建方式均采用Roux-en-Y胆管空肠吻合术。比较术后两组患者肛门排气时间、排便时间、下床活动时间、拔除腹腔引流管时间和术后住院时间;比较两组患者术后并发症发生情况;检测两组患者术后1、3、6d血清c反应蛋白、前白蛋白和TBil变化情况。出院后至术后1个月由主治医师每天电话随访,了解患者病情变化情况。正态分布的计量资料用x±s表示,组问比较采用两独立样本t检验,重复测量数据采用重复测量方差分析,计数资料比较采用,检验或Fisher确切概率法。结果筛选出符合研究条件的患者60例,男25例,女35例;年龄21~65岁,平均年龄48岁。ERAS组和对照组患者各30例,所有人组患者术前行营养支持治疗后的营养风险评估总分〈3分。ERAS组患者术后肛门排气时间、排便时间、下床活动时间、拔除腹腔引流管时间、术后住院时间分别为(54±12)h、(72±14)h、(19±5)h、(3.9±0.9)d、(7.4±0.9)d,均短于对照组的(84±12)h、(104±13)h、(53±8)h、(6.7±1.1)d、(10.5±1.4)d,两组比较,差异有统计学意义(t=9.969,9.385,19.328,10.521,10.307,P〈0.05)。ERAS组和对照组患者术后发生伤口感染、肺部感染和胆汁漏的例数分别为2例和3例、1例和3例、1例和2例,两组比较,差异无统计学意义(P〉0.05);但ERAS组和对照组患者咽喉疼痛和恶心呕吐分别为2例和14例� 展开更多
关键词 肝胆管结石病 胆肠吻合 加速康复外科
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犬胆肠吻合愈合过程的组织学观察 被引量:6
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作者 耿智敏 向国安 +4 位作者 刘效恭 韩庆 王康敏 刘青光 潘承恩 《西安医科大学学报》 CAS CSCD 2000年第5期446-448,共3页
目的 观察胆肠吻合愈合过程的组织学变化,探讨良性胆管狭窄形成机制。方法 通过制作犬胆总管十二指肠吻合模型,分别于术后3d、1周、3周、3月、6月取材行HE染色、Masson染色及Verhoeff's染色,并进行计算机图像分析测定粘膜下胶原... 目的 观察胆肠吻合愈合过程的组织学变化,探讨良性胆管狭窄形成机制。方法 通过制作犬胆总管十二指肠吻合模型,分别于术后3d、1周、3周、3月、6月取材行HE染色、Masson染色及Verhoeff's染色,并进行计算机图像分析测定粘膜下胶原纤维面积百分比。结果 胆肠吻合愈合过程延长,慢性炎症持续存在,胆道粘膜上皮修复较差,成纤维细胞增生活跃,愈合后粘膜下胶原纤维过度沉积,改建较差。结果导致瘢痕增生,吻合口狭窄。结论 胆肠吻合愈合方式属于过度愈合,其原因与胆管壁组织构筑、胆汁刺激作用及肠胆返流有关。 展开更多
关键词 胆肠吻合 伤口愈合 组织学 胆管狭窄
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腹腔镜下再次胆肠吻合治疗良性胆肠吻合口狭窄探讨 被引量:10
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作者 李宇 张军强 +3 位作者 王铮 仵正 吕毅 刘学民 《中国实用外科杂志》 CSCD 北大核心 2020年第11期1314-1319,共6页
目的探讨腹腔镜下再次胆肠吻合在治疗良性胆肠吻合口狭窄(BBEAS)中的可行性和有效性。方法采用回顾性病例对照研究。2017年1月至2019年6月,11例行开放手术后BBEAS病人再行腹腔镜下再次胆肠吻合术治疗(腹腔镜组),同期有13例BBEAS病人接... 目的探讨腹腔镜下再次胆肠吻合在治疗良性胆肠吻合口狭窄(BBEAS)中的可行性和有效性。方法采用回顾性病例对照研究。2017年1月至2019年6月,11例行开放手术后BBEAS病人再行腹腔镜下再次胆肠吻合术治疗(腹腔镜组),同期有13例BBEAS病人接受经皮经肝穿刺胆道引流(PTCD)+球囊扩张治疗(PTCD组)。对比两组病人一般资料、治疗相关参数及随访结果。结果腹腔镜组诊断BBEAS时间晚于PTCD组,余术前资料两组类似。两种方式治疗BBEAS的成功率(10/11 vs.12/13,χ^2=0.15,P=0.9)及相关并发症发生率(1/10 vs.11/57,χ^2=0.5,P=0.48)类似,但腹腔镜组在治疗所需中位时间(14 d vs.161 d,Z=-3.5,P=0)、所需平均治疗次数(1.0次/例vs.4.4次/例,T=-6.4,P=0)明显少于PTCD组。术后随访26.0±10.8个月,两组吻合口狭窄复发比例(1/10vs.4/12,χ^2=1.7,P=0.19)差异无统计学意义。结论腹腔镜下再次胆肠吻合术治疗良性胆肠吻合口狭窄安全、效果良好。 展开更多
关键词 腹腔镜 胆肠吻合狭窄 二次手术 经皮经肝胆道引流 狭窄复发
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加速康复外科在肝胆外科胆肠吻合术围术期的应用价值 被引量:9
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作者 杜利 《保健医学研究与实践》 2017年第3期55-58,共4页
目的探讨加速康复外科(ERAS)在肝胆外科胆肠吻合术围术期的应用价值。方法选取2012年12月-2014年12月合肥市某医院收治的60例肝胆管结石患者为研究对象,随机分为观察组与对照组,每组30例。患者均行胆肠吻合术进行治疗,观察组患者采用ERA... 目的探讨加速康复外科(ERAS)在肝胆外科胆肠吻合术围术期的应用价值。方法选取2012年12月-2014年12月合肥市某医院收治的60例肝胆管结石患者为研究对象,随机分为观察组与对照组,每组30例。患者均行胆肠吻合术进行治疗,观察组患者采用ERAS围术期处理方案,对照组患者采用传统围术期处理方案。比较2组患者术后恢复情况,主要包括肛门排气时间、排便时间、下床活动时间、腹腔引流管拔除时间、住院时间和并发症发生情况。同时检测并比较2组患者术后第1天、第3天及第6天血清C反应蛋白(CRP)、前白蛋白(PA)及总胆红素(TBIL)水平。结果观察组患者术后肛门排气时间、排便时间、下床活动时间、腹腔引流管拔除时间、住院时间均短于对照组,差异均有统计学意义(P<0.05);观察组患者术后咽喉疼痛、恶心呕吐发生率低于对照组,差异有统计学意义(P<0.05);观察组患者术后第1天、第3天及第6天血清CRP水平低于对照组,差异有统计学意义(P<0.01),观察组患者术后第3天及第6天血清PA水平高于对照组,差异有统计学意义(P<0.01)。结论在肝胆外科胆肠吻合术围术期采用ERAS处理方案,可减轻患者因手术因素导致的不良应激反应,促进患者胃肠功能恢复及术后康复,缩短住院时间,值得临床推广应用。 展开更多
关键词 加速康复外科 肝胆管结石 胆肠吻合术
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急性胆管损伤后应用磁性胆肠吻合支架一期修复胆肠连续性的实验研究 被引量:9
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作者 李建辉 吕毅 +6 位作者 张智勇 刘昌 史源 王博 季学闻 于良 耿智敏 《中华肝胆外科杂志》 CAS CSCD 2007年第11期767-770,共4页
目的评价自行研制的无缝线磁性胆肠吻合支架在犬急性胆管损伤后、胆管炎症较重的情况下,一期修复胆肠连续性的可行性。方法制造犬的急性胆管损伤并胆汁性腹膜炎模型,在胆管炎症较重的情况下应用磁性胆肠吻合支架进行胆肠连续性的一期修... 目的评价自行研制的无缝线磁性胆肠吻合支架在犬急性胆管损伤后、胆管炎症较重的情况下,一期修复胆肠连续性的可行性。方法制造犬的急性胆管损伤并胆汁性腹膜炎模型,在胆管炎症较重的情况下应用磁性胆肠吻合支架进行胆肠连续性的一期修复,观察吻合效果,并与传统手工吻合方式进行比较。结果研制的吻合支架一期修复犬胆肠连续性安全可靠,无吻合口漏和感染发生;胆道造影显示吻合口通畅,无明显狭窄。组织学检查显示吻合口愈合良好,炎症反应小,胶原排列整齐。结论该吻合支架在胆管炎症较重的情况下,进行胆肠连续性的一期修复是安全而且可行的。 展开更多
关键词 胆管损伤 胆肠吻合 修复
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磁环构建大鼠胆肠吻合模型的实验研究 被引量:8
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作者 吉琳 常凯曦 +4 位作者 王俊翔 李一鹤 王伊睿 吕毅 严小鹏 《中国医疗设备》 2020年第11期49-51,共3页
目的探讨磁环构建大鼠胆肠吻合模型的可行性。方法设计并加工适用于大鼠胆肠吻合模型的磁环。10只雄性SD大鼠结扎胆总管,2周后胆总管扩张。利用磁环完成胆总管十二指肠吻合操作。记录吻合时间、术后存活率及并发症发生情况。28 d后获取... 目的探讨磁环构建大鼠胆肠吻合模型的可行性。方法设计并加工适用于大鼠胆肠吻合模型的磁环。10只雄性SD大鼠结扎胆总管,2周后胆总管扩张。利用磁环完成胆总管十二指肠吻合操作。记录吻合时间、术后存活率及并发症发生情况。28 d后获取吻合口标本,肉眼观察胆肠吻合口愈合情况。结果10只SD大鼠中,1只大鼠胆总管结扎后1周出现胆漏并死亡,1只因胆总管未见明显扩张而剔除实验,其余8只大鼠利用磁环顺利完成胆肠吻合手术操作,平均吻合时间(5.22±1.83)min。术后28 d获取胆肠吻合口标本,肉眼观察可见吻合口黏膜层连续性良好,吻合口通畅。结论磁环可用于构建大鼠胆肠吻合模型,且具有操作简单、吻合效果可靠等优点。 展开更多
关键词 磁吻合 大鼠 胆肠吻合 动物模型 磁外科
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经皮经肝胆道镜治疗胆肠吻合口良性狭窄九例的临床效果 被引量:8
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作者 朱沂 赵华 +3 位作者 谢敏杰 李亮平 金晶 楼健颖 《中华外科杂志》 CAS CSCD 北大核心 2021年第4期289-292,共4页
目的探讨经皮经肝胆道镜(PTCS)治疗胆肠吻合术后吻合口良性狭窄的可行性和有效性。方法回顾性分析2016年4月至2020年4月于浙江大学医学院附属第二医院肝胆胰外科因考虑胆肠吻合术后吻合口狭窄行PTCS下扩张成形、肝内胆管取石治疗的9例... 目的探讨经皮经肝胆道镜(PTCS)治疗胆肠吻合术后吻合口良性狭窄的可行性和有效性。方法回顾性分析2016年4月至2020年4月于浙江大学医学院附属第二医院肝胆胰外科因考虑胆肠吻合术后吻合口狭窄行PTCS下扩张成形、肝内胆管取石治疗的9例患者的临床资料。男性7例,女性2例,年龄40~76岁。该手术分为两期,一期行超声引导下经皮肝内胆管穿刺,置入鞘管固定,二期待窦道形成后经皮胆道镜行吻合口狭窄钬激光+球囊扩张术。治疗后通过肝胆相关生化指标等评估治疗效果。结果9例患者的手术时间为(53.3±31.0)min(范围:15~120 min),术后住院时间为(4.4±2.3)d(范围:2~9 d)。经治疗后,9例患者术前腹痛、黄疸、发热寒战等症状消失;术前碱性磷酸酶为122~1334 U/L,术后为85~702 U/L;术前γ-谷氨酰转肽酶为44~1219 U/L,术后为46~529 U/L。结论PTCS手术治疗过程安全,可有效扩张胆肠吻合口狭窄,是治疗胆肠吻合口狭窄的可选术式。 展开更多
关键词 外科吻合口 手术后并发症 胆肠吻合口狭窄 经皮经肝胆道镜
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腹腔镜与开放胆肠内引流重建术治疗胆肠吻合口狭窄安全性与近期疗效观察:一项倾向性评分匹配研究 被引量:8
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作者 何翔宇 周杰 +4 位作者 尹新民 成伟 陈宇泰 周卫 刘毅 《中国实用外科杂志》 CAS CSCD 北大核心 2022年第9期1010-1015,共6页
目的比较腹腔镜与开放胆肠内引流重建术治疗胆肠吻合口狭窄的安全性与近期临床疗效。方法回顾性分析2018年1月至2020年12月湖南省人民医院收治的250例吻合口狭窄病人的临床资料。根据手术方式分为腹腔镜手术(腹腔镜组,39例)和开放手术(... 目的比较腹腔镜与开放胆肠内引流重建术治疗胆肠吻合口狭窄的安全性与近期临床疗效。方法回顾性分析2018年1月至2020年12月湖南省人民医院收治的250例吻合口狭窄病人的临床资料。根据手术方式分为腹腔镜手术(腹腔镜组,39例)和开放手术(开放组,211例)。通过术前基线资料及术中是否行输入袢重建按照最邻近匹配法进行倾向性评分匹配(卡钳值设置为0.01),评分匹配后分组为腹腔镜手术组(腹腔镜组,31例)和开放手术组(开放组,31例),比较两组术中情况(手术时间,术中失血量),术后情况[术后住院时间,术后肛门排气时间,术后炎性指标(第1天及第5天C-反应蛋白、术后第1天降钙素原),术后并发症(出血、胆漏、切口感染、结石残留)]及出院后随访近期并发症(反流性胆管炎、吻合口再狭窄等)等相关指标。结果腹腔镜组与开放组病人在手术时间[(332.58±118.77)min vs.(279.03±97.22)min,P=0.057]、术后住院时间[(12.00±5.16)d vs.(14.84±9.32)d,P=0.143]上差异无统计学意义,但腹腔镜组较开放组术中失血量较少[(107.10±101.99)mL vs.(212.90±225.09)mL,P=0.022],术后肛门排气时间较短[(2.06±0.57)d vs.(2.65±0.76)d,P=0.001],术后炎性指标较低:术后第1天C-反应蛋白[(103.92±34.02)mg/L vs.(129.07±29.37)mg/L,P=0.003],术后第5天C-反应蛋白[(12.09±9.35)mg/L vs.(21.42±14.03)mg/L,P=0.003],术后第1天降钙素原[(0.69±0.55)μg/L vs.(1.72±2.23)μg/L,P=0.017],差异有统计学意义。以上均无死亡病例及非计划再手术病例,腹腔镜组无中转开放手术病例。腹腔镜组术后发生胆瘘2例,切口感染2例,结石残留3例,无术后出血病例;开放组术后发生胆瘘2例,切口感染4例,结石残留3例,无术后出血病例,胆瘘、切口感染经保守治疗后好转出院,结石残留出院后经T管窦道胆道镜取石后治愈,两组间术后并发症发生率比较差异无统计学意义(P>0.05)。随访12~48个月,所有病� 展开更多
关键词 腹腔镜 胆肠吻合口狭窄 再手术 重建
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碱性成纤维细胞生长因子预防胆肠吻合口狭窄的实验研究 被引量:6
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作者 徐军 耿智敏 +4 位作者 刘青光 刘效恭 韩庆 王康敏 陈明霞 《西安医科大学学报》 CAS CSCD 北大核心 2002年第3期262-264,共3页
目的 观察碱性成纤维细胞生长因子 (bFGF)对胆肠吻合愈合过程的影响 ,预防术后胆肠吻合口狭窄。方法 通过制作犬胆总管十二指肠吻合模型 ,术后一周内吻合口局部应用bFGF(实验组 ) ,并与生理盐水组对照。两组术后不同时期分别取材行光... 目的 观察碱性成纤维细胞生长因子 (bFGF)对胆肠吻合愈合过程的影响 ,预防术后胆肠吻合口狭窄。方法 通过制作犬胆总管十二指肠吻合模型 ,术后一周内吻合口局部应用bFGF(实验组 ) ,并与生理盐水组对照。两组术后不同时期分别取材行光镜、电镜观察及羟脯氨酸含量分析。结果 bFGF能显著促进胆肠吻合口粘膜上皮愈合过程 ,促进肉芽组织生长及伤口收缩 ,减少瘢痕形成。结论 吻合口局部应用bFGF是预防术后胆肠吻合口狭窄的一种有效措施 ,其机制与bFGF能够①促进创面巨噬细胞增生、活化 ;②促进肉芽组织生长 ;③促进伤口收缩 ; 展开更多
关键词 碱性成纤维细胞生长因子 吻合口狭窄 BFGF 胆肠吻合 瘢痕 术后并发症
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碱性成纤维细胞生长因子对胆肠吻合口愈合的影响 被引量:3
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作者 徐勇 耿智敏 王居邠 《中国修复重建外科杂志》 CAS CSCD 北大核心 2005年第5期341-343,共3页
目的 观察碱性成纤维细胞生长因子( basic fibroblast growth factor,b FGF)对胆肠吻合口愈合过程的影响,预防术后吻合口狭窄。 方法 选用健康杂种犬31只,随机分为实验组16只,对照组15只。通过制作犬胆总管十二指肠吻合模型,术后1周... 目的 观察碱性成纤维细胞生长因子( basic fibroblast growth factor,b FGF)对胆肠吻合口愈合过程的影响,预防术后吻合口狭窄。 方法 选用健康杂种犬31只,随机分为实验组16只,对照组15只。通过制作犬胆总管十二指肠吻合模型,术后1周内吻合口局部应用b FGF(实验组)及生理盐水(对照组)。术后3d,1、3周,3、6个月( n=3)分别取材行HE及Masson染色组织学观察,吻合口瘢痕组织羟脯氨酸含量测定。 结果 实验组较对照组愈合时间明显缩短。组织学见实验组肉芽组织中成纤维细胞及毛细血管增生,上皮增生明显加快,1周时开始修复,3周时基本完成,瘢痕亦已基本定型,胶原纤维排列整齐有序,较快( 2~3周左右)进入塑形期;对照组术后3周时胶原纤维排列杂乱,呈旋涡状。电镜观察实验组肉芽组织中细胞功能旺盛,胞浆丰富,粗面内质网发达。瘢痕组织羟脯氨酸含量术后各时间点实验组均小于对照组,差异有统计学意义( P<0 .0 5 )。 结论 吻合口局部应用b 展开更多
关键词 碱性成纤维细胞生长因子 肠吻合口愈合 胆总管十二指肠吻合 Masson染色 术后吻合口狭窄 胆肠吻合口狭窄 factor 毛细血管增生 局部应用 瘢痕组织 肉芽组织 胶原纤维 实验组 对照组 组织学观察 粗面内质网 愈合过程 生理盐水
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