皮下盲袢型胆肠吻合术治疗肝门部胆管狭窄合并肝内胆管结石

Subcutaneous Free Jejunal Loop Cholangiojejunostomy for Hepatolithiasis Accompanied with Bile Stricture Near Hepatic Hilum

目的总结皮下盲袢型胆肠吻合术治疗肝门部胆管狭窄合并肝内胆管结石的经验及治疗效果。方法肝门部胆管狭窄合并肝内胆管结石53例,采取皮下盲袢型胆肠吻合,其中皮下盲袢Roux-en-Y型33例(62.3%);皮下盲袢间置空肠型5例(9.4%);皮下盲袢间置空肠胆道腹壁型15例(28.3%)。结果术后发生近期并发症6例:胆漏2例,胆道出血1例,切口感染3例;远期并发症5例:反流性慢性胆管炎2例,胆肠吻合口狭窄2例,吻合口癌1例。残石率13.2%,优良率88.6%,结石复发率6.8%。术后经皮下盲袢行胆道镜取石10例(残余结石7例,复发结石3例),扩张吻合口狭窄2例,活检1例。结论皮下盲袢型胆肠吻合术是治疗肝门部胆管狭窄合并肝内胆管结石的有效手段。

Objective To summarize the therapeutic experiences and efficacy of free jejunal loop cholangiojejunostomy in treatment of hepatolithiasis accompanied with bile stricture near hepatic hilum. Methods 53 cases of hepatolithiasis accompanied with bile stricture near hepatic hilum received free jejunal loop eholangiojejunostomy. The ways of cholangiojejunostomy included Roux-en-Y in 33 （62.3%）, jejunal interposition in 5 （9.4%） , and jejunal interposition as trans-abdominal wall bile duct in 15 （28.3%）. Results 6 cases occurred short-term complications including 2 of bile leakage, 1 of bile duct hemorrhage, and 3 of incisional infection. And 5 cases occurred long-term complications, in which chronic： refluxing cholangitis in 2, cholangiojejunostomy stoma stricture in 2 and stoma cancer in 1 case. The rate of calculus residuum was 13.2% ,of fineness was 88.6% , of calculus relapse was 6.8%. Through the subcutaneous free jejunal loop, 10 received calculus removing by choledochoscope, 2 received dilation of the stenotic stoma, and 1 of biopsy. Conclusion The free jejunal loop cholangiojejunostomy is effectual on treatment of hepatolithiasis accompanied with stricture of bile duct near hepatic hilum.