胆总管取石术后发生下端梗阻的原因分析及处理

Causes and treatment of distal common bile duct obstruction after the operation of common bile duct exploration

目的分析胆总管探查取石术后发生下端梗阻的原因及采取的对策效果,为临床治疗胆总管结石及解决梗阻提供参考,减少胆总管探查取石术后发生下端梗阻。方法收集2013年1月至2015年12月间在深圳市第六人民医院行胆总管探查取石术后发生下端梗阻19例病人的一般资料及术前、术中和术后的临床资料,分析胆总管探查取石术后发生下端梗阻的原因,之后对病人采取的医疗对策并随访效果。结果 1胆总管下端良性狭窄引起的下端梗阻5例,行内镜下十二指肠乳头括约肌切开术(EST)治疗,术后随访6个月行腹部彩超、生化检查复查,结果显示均无异常。2胆总管下端嵌顿性结石引起的下端梗阻9例,行内镜逆行胰胆管造影(ERCP)+EST术治疗,术后随访6个月均无异常。3胰头部病变引起的下端梗阻5例,其中胰头慢性胰腺炎2例,行胆肠Roux-en-Y吻合术治疗,术后随访6个月无异常,复查腹部CT胰头无明显炎性改变;肝胰壶腹癌1例,胰头癌2例,均行胰十二指肠切除术治疗,术后随访1年均无复发转移。结论对于不具有典型胆总管结石临床表现的病人,或者胆总管结石直径明显小于胆总管内径,而胆总管却有明显扩张的病人,应该引起重视。术前、术中均应该进行严格排查,术中应"重探查、轻取石",找到胆总管梗阻的真正原因。

Objective To investigate the causes and treatment of common bile duct obstruction after the operation of common bile duct exploration and T-tube drainage in order to provide a reference for common bile duct obstruction and reduce occurrence of common bile duct obstruction after the operation of common bile duct exploration and T-tube drainage.Methods General information and preoperative,intraoperative and postoperative clinical data of patients were collected from January 2013 to December 2015,whice could work for search of reason of distal common bile duct obstruction.Thereafter,doctor took medical measures based on the reasons and followed-up results.Results There were 5 cases of benign distal bile duct stenosis,which was given endoscopic sphincterotomy treatment.During a postoperative follow-up period of 6months,abdominal ultrasound and biochemical examination showed no abnormalities.There were 9 cases of distal common bile duct stones incarcerated,which was given endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy treatment.During a postoperative follow-up period of 6 months,abdominal ultrasound and biochemical examination showed there were no abnormalities.There were 5 cases of pancreatic head lesions,including 2 cases of pancreatic head of chronic pancreatitis,which was given biliary enteric Roux-en-Y anastomosis.During a postoperative follow-up period of 6 months,CT examination of the head of the pancreas showed no obvious inflammation; 1 case of ampulla carcinoma and 2 cases of carcinoma of head of pancreas,which were treated with,and no recurrence and metastasis occurred during a postoperative follow-up period of one year.Conclusions The attention should be paid to the common bile duct stones complicated with distal bile duct lesions,when patients have no typical clinical manifestations of the common bile duct stones or the diameter of common bile duct stones is obviously less than the common bile duct but obvious common bile duct expansion exists.Therefore,a rigorous preoperative and intraoperative investigation should be carried out.The principle of operation should be ＂ exploration wins over stone＇.It is important to find the real cause of the common bile duct obstruction.