胆肠吻合在肝胆管结石治疗中的合理应用

Reasonable application of bilioenterostomy in the treatment of hepatolithiasis

肝胆管结石病情复杂,其预后与胆道引流通畅程度密切相关。而胆肠吻合,尤其是经典的胆总管空肠Roux-en-Y吻合术作为肝胆管结石外科治疗中胆道引流的重要方式,已经有很长的历史。由于Oddi括约肌功能废弃,胆肠吻合仍存在反流性胆管炎等问题,为此该术式被不断改良,然而目前并无一种胆肠吻合术式能完全避免以上问题。只有严格掌握胆肠吻合的适应证,运用适当的吻合材料和熟练的吻合技术,按照规范进行操作,才能提高肝胆管结石病人的远期疗效。

Hepatolithiasis is a complicated disease and its prognosis is correlated with bile drainage.As an important surgical method for biliary drainage, bilioenterostomy, especially the Roux-en-Y eholedochojejunostomy has a long history in the surgical treatment of hepatobiliary lithiasis.The surgical method has been modified continuously due to reflux cholangitis caused by the abandoned Oddis sphincter. However, no bilioenterostomy could completely avoid those problems.Only when indications, proper application of anastomosis material, practiced anastomosis skill and procedures of the choledochojejunostomy are followed strictly can improve the lone-term effect of henatolithinsis.