先天性胆总管囊肿切除后不同胆道重建术的疗效

Therapeutic effect of different types of biliary tract reconstruction after resection of congenital choledochal cyst

目的 评价先天性胆总管囊肿切除后不同胆道重建术的疗效。 方法 对行囊肿切除、肝总管空肠Roux -en -Y吻合重建胆道的 10 6例先天性胆总管囊肿病例进行回顾性分析和随访复查。结果 在 10 6例重建的胆道中 ,胆支空肠袢套叠瓣成形 37例 ,矩形瓣成形 2 1例 ,未做抗反流瓣 48例。获随访 6 1例 ,平均 4.82年。无 1例发生吻合口狭窄 ;逆行性胆道感染 4例 (矩形瓣组 1例 ,未做抗反流瓣组 3例 ) ,2例再手术并于胆支空肠袢套叠瓣成形后症状消失 ;偶有腹痛症状 8例 ,其中未做抗反流瓣组 5例 ,矩形瓣成形组 2例 ,套叠瓣成形组 1例。 结论 在先天性胆总管囊肿切除后胆道重建中 ,肝总管空肠Roux -en -Y吻合加胆支空肠袢套叠瓣成形术符合胆道生理。

Objective To evaluate the therapeutic effect of different types of biliary tract reconstruction on the post- resection of congenital choledochal cyst (CCC). Methods 106 cases of CCC undergoing resection of CCC with Roux-en-Y hepaticojejunostomy as biliary tract reconstruction were followed up and analysed. Results In this series, three kinds of biliary tract reconstruction were performed, including single Roux-en-Y hepaticojejunostomy in 48 cases, intussusceptive valve and rectangular valve lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy in 37 and 21 cases, respectively. 61 cases were followed up for 4.82 years in average. None of them occurred anastomasis stricture. There were 4 cases with ascending cholangitis after primary operation: of them 3 after single Roux-en-Y hepaticojejunostomy; symptoms of 2 out of the 3 cases disappeared after reoperation to set up an intussusceptive valve plasty on the jejunal segmental of Roux-en-Y hepaticojejunostomy; another one was in rectangular valve group. Occasional abdominal pain tooke place in 8 patients, of them, 5 in single Roux-en-Y hepaticojejunostomy group, 2 and 1 in intussusceptive valve and rectangular valve groups, respectively. No patients suffered from ascending cholangitis in the intussusceptive valve plasty group. Conclusions The postoperative ascending cholangitis and anastomasis stricture can be prevented effectively, if a prophylactic intussusceptive valve on the jejunal segmental of Roux-en-Y hepaticojejunostomy is carried out after resection of CCC for biliary tract reconstruction. This procedure corresponds to the biliary tract physiology.