肝胆管结石胆肠Roux-en-Y吻合术后再手术的临床分析

Clinical Analysis of Hepatolith Bravery Roux e -Y Anastomosis Postoperatively Surgery

目的探讨胆肠Roux-en-Y吻合术后再手术的原因及处理方法。方法回顾性分析1995年1月至2009年12月56例胆肠Roux-en-Y吻合术后再手术患者的临床资料。结果再手术的原因包括:肝胆管结石残留或复发36例,胆肠吻合口瘢痕狭窄23例,两者合并存在13例,合并顽固性胆道感染17例;胆管癌变6例;游离空肠袢梗阻4例。再手术方式为:56例均行胆管空肠吻合口切开探查,其中吻合口扩大整形或瘢痕性狭窄切除再吻合32例,吻合口癌灶切除再吻合3例,联合肝切除24例。游离空肠袢切除恢复原oddi括约肌通路3例,重行胆管空肠Roux-en-Y吻合11例。缝闭或切断关闭原胆肠吻合术中未缝闭的胆总管远端者17例。结论肝内胆管结石残留复发及吻合口瘢痕狭窄是再手术的主要原因,充分的术前准备、术中良好显露并切开原胆肠吻合口是再次手术成功的关键,应根据术中具体情况选择正确术式。

Objective To investigate the causes of reoperation and its strategic for biliary lithiasis which after operation of biliary-enteric anastomosis Roux- en-Y. Methods The 56 cases who underwent reoperation for hepatolithiasis afer operation of biliary-enteric anastomosis Roux-en-Y from January 1995 to December 2009 were retrospectively reviewed. Results The causes of reoperation included the residual or recurrent stones of bile duet in 36 cases, the biliary- enteric anastomosis scar stenosis in 23 cases and 13 cases combined both of the above, 17 cases combined with the refractory biliary tract infection, the bile duct cancer in 6 eases and the free jejunal loop obstruction in 4 cases. Chiose of surgical approach ofreoperation： Exploration of cholangiojejunum anastomosis is all of the 56 cases including 32 cases for expansion of anastomotic stricture scar removal surgery or re-anastomosis, 3 cases for re-anastomosis after resection of anastomotic stricture carcinoma and 24 cases combined with hepatic resection. Free jejunal loop excision pathway to restore the original oddi sphincter in 3 cases, re-bile duct jejunum Roux-en-Y anastomosis in 11 cases. 17 cases of primary biliary-enteric anastomosis is not cut or sutured distal common bile duct who are sewn closed or cut off. Conclusion The main causes of re-operation included hepatolithiasis recurrence and cholangiojejunum anastomotic stenosis. The key of successful operation is adequate preoperative preparation, well exposure of operating region and original biliary-enteric anastomosis Incision. To choose the correct surgical approach should be based on specific situation in surgery.