胆总管囊肿切除后一种防返流的胆肠吻合术式

A Method to Prevent Biliary Reflux in Hepaticojejunostomy after Excision of Choledochal Cyst

目的:探讨先天性胆总管囊肿切除后有效预防胆肠返流的胆道重建手术方法。方法:胆总管囊肿切除之后,行Roux-en-Y胆肠吻合,胆道支与近端空肠支吻合前制作双重全层U形瓣,宽度与长度为肠管周径的1/2,瓣膜基底部在上,两瓣浆膜层相对边缘间断缝合,然后将近端空肠与远端空肠端侧吻合。将胆道支空肠于U形瓣基底部上方横行浆肌层缝合使肠管缩窄1/3,缩窄长度为5cm。再将远近空肠浆肌层并行缝合5cm以上使之形成Y形。结果:临床应用于11例病人,术后随访0.5-6年,均未出现胆系感染表现,钡餐检查各种体位并加压时均无返流。结论:胆总管囊肿切除后行Roux-en-Y胆道重建时加做胆道支空肠缩窄及双重U形瓣的防返流术效果可靠,简单易行。

Objective： To explore a more effective method to deduce or avoid billiary reflux after excision of congenital choledochal cyst （CCC）. Methods： After hepaticojejunostomy with Roux-en-Y, two pieces of U-like valve at the distal anastomotic stoma of jejunum were made and suited together. Then the proximal jejunum above the anastomotic stoma of jejunum was sutured longitally for about 5 cm so as to narrow the proximal jejunum to approximately 2/3 of its oringinal width. Then the two branches of jejunum were sutured together longitally above the anastomotic stoma for about 5 cm. Results： Eleven cases of CCC were treated with this method. No one died or had complications. There was no refluxed cholangitis during the follow-up of 0. 5 to 6 years. Conclusion：The procedure of narrowing the proximal jejunum and adding dual U-like valves to prevent biliary reflux proved to be effective in preventing biliary reflux in hepaticojejunostomy after excision of choledochal cyst in the treatment of congenital choledochal cyst.