经皮下空肠盲襻胆道镜治疗胰十二指肠切除术后严重并发症10例报告

Treatment of severe complications after pancreatoduodenectomy under fiber choledochoscope through a subcutaneous jejunal blind loop: A report of 10 cases

目的 探讨胆道镜经皮下空肠盲襻诊断和治疗胰十二指肠切除术后严重并发症的价值。 方法 从皮下空肠盲插入胆道镜 ,直视下对胰肠、胆肠吻合口漏涂抹生物胶或对吻合口出血喷涂止血药物。 结果 5例肠漏 ,3例胆漏和 2例吻合出血均治愈。 10例随访 1～ 3年 ,未发现肿瘤复发 ,1例术后 1年胆肠吻合口狭窄 ,胆道镜扩张吻合口狭窄治愈 ,余 9例胰液、胆汁排泌通畅。 结论 胆道镜经皮下空肠盲襻能对胰十二指肠切除术后并发症进行诊治 ,对胰肠、胆肠吻合口进行远期直观随访。

Objective To discuss the value of choledochoscopy via subcutaneous jejunal blind loop in the diagnosis and treatment of severe complications after pancreatoduodenectomy. Methods A fiber choledochoscope (FCC) was introduced through a subcutaneous jejunal blind loop. Under direct vision, the pancreatojejunal or choledochojejunal anastomotic leakages were coated with biological glue, or the anastomotic bleedings were stopped with hemostatic drugs. Results Five cases of intestinal leakage, 3 cases of biliary leakage and 2 cases of anastomotic bleeding were all cured. Follow-up for 1～3 years in the 10 cases found no recurrence of tumors. Choledochojejunal anastomotic stricture occurred in 1 case 1 year after the surgery and was cured by dilatation under fiber choledochoscope. In the remaining 9 cases, the pancreatic juice and bile fluid were excreted normally. Conclusions Application of FCC through the subcutaneous jejunal blind loop can be employed in the diagnosis and treatment of complications after pancreatoduodenectomy and in the long-term follow-up of pancreatojejunal or choledochojejunal anastomotic stoma under direct vision.