胆总管十二指肠吻合术后再手术(34例分析)

Analysis of 34 Reopertive Patients after Cholledochoduodenostomy

本文对1981～1991年间胆总管十二指肠吻合术后再手术34例作了分析,再手术发现肝内胆管结石或狭窄8例,胆肠吻合口狭窄16例,返流性阻管炎5例,继发性硬化性胆管炎2例,胆管癌3例。认为肝内残留病灶,术式选择不当及手术实施失误为此术式严重并发症的三个主要因素。指出胆总十二指肠吻合术只适用于肝内病灶已清除的老年患者及恶性梗阻的姑息性内引流术。并要求低位,粘膜对合及吻合口足够大。

Between 1981 and 1991, another choledochostomy was performed upon 34 patients three months to ten years after their initial choledochoduodenostomy. Surgical explorations demonstrated that intrahepatic calculi was in 8, anastomotic stricture in 16, ascending (reflux) cholangitis in5, secondary sclerosing cholangitis in 2 and ductal cancer in 3, The three major factors responsible for these complications were residual intrahepatic lesion, inadequate elective procedure and undesirable surgical technique, which suggested that choledochoduodenostomy is reserved for those elderly patinets whose intrahepatic lesion has been well treated and those with malignant obstruction, that a palliative internal drainage is required Nevertheless, a size-sufficient, lowerposition and mueosa-to-mucosa anastomosis is desirable.