胆管空肠Roux-Y型吻合术后逆行性胆道感染的临床诊断及治疗

Clinical diagnosis and treatment of retrograde biliary tract infections after bile duct jejunum Roux-Y type anastomosis

目的探讨胆管空肠Roux-Y型吻合术后逆行性胆道感染临床诊治情况,以期提高临床治疗水平。方法选取2010年4月-2013年4月105例胆管空肠Roux-Y型吻合术患者为研究对象,对其中19例发生逆行性胆道感染的患者从临床表现、辅助检查、影响因素和治疗进行总结。结果术后逆行性胆道感染有腹痛腹胀、恶心呕吐、寒颤、高热等症状,可触及隆起的肠管;结合超声和总胆红素、直接胆红素、碱性磷酸酶、谷氨酰转移酶、白细胞计数、C-反应蛋白等可确诊;其中吻合口直径(<2cm)、吻合口以上胆管狭窄、胆管严重损失、失功肠襻肠梗阻、上行肠襻长度(≥70cm)、近侧肠襻(≥20cm)为危险因素(P<0.05);治疗后总有效15例,总有效率为78.95%。结论胆管空肠Roux-Y型吻合术后逆行性胆道感染影响因素较多,临床上对症治疗后预后较好。

OBJECTIVE To explore the clinical diagnosis and treatment of retrograde biliary tract infections after bile duct jejunum Roux‐Y type anastomosis so as to improve the level of clinical treatment .METHODS A total of 105 patients who underwent the bile duct jejunum Roux‐Y type anastomosis from Apr 2010 to Apr 2013 were re‐cruited as the study objects ,then the clinical manifestations ,laboratory examinations ,influencing factors ,and treatment of the patients with retrograde biliary tract infections were observed .RESULTS The patients with the postoperative retrograde biliary tract infections had the clinical symptoms such as the abdominal pain ,abdominal distension ,nausea ,vomiting ,chills ,and fever ,which were palpable bulge bowels ;the cases could be diagnosed through the ultrasound in combination with the total bilirubin ,direct bilirubin ,alkaline phosphatase ,glutamyl transferase ,white blood cell counts ,and C‐reactive protein .The anastomotic diameter less than 2cm ,upper anastomotic biliary stricture ,severe damage of bile duct ,dysfunction intestinal loop obstruction ,length of up‐stream intestinal loop no less than 70 cm ,and length of proximal intestinal loop no less than 20cm were the risk factors （P〈0 .05） .The treatment was effective in 15 cases with the total effective rate of 78 .95% .CONCLUSION There are a variety of influencing factors for the retrograde biliary tract infections after bile duct jejunum Roux‐Y type anastomosis ,and the prognosis is satisfying after the clinical symptomatic treatment .