儿童先天性胆管扩张症术后胆肠吻合口狭窄再手术分析

Reoperation for biliary-enteric strictures after hepaticojejunostomy in children with congenital biliary dilatation

目的:探讨儿童先天性胆管扩张症术后胆肠吻合口狭窄的诊治经验。方法:回顾性分析2012年4月至2019年10月24例先天性胆管扩张症术后因胆肠吻合口狭窄在北京儿童医院普通外科接受手术治疗患儿的临床资料。结果:24例患儿中,男6例,女18例,根据初次手术后有无出现胆肠吻合口漏分为胆漏组及无胆漏组。胆漏组6例,黄疸及持续肝功损害是其主要表现;无胆漏组18例,以反复发作的胆管炎为特点。胆漏组初次术后出现症状中位时间为7.0个月(3~13个月),明显早于无胆漏组初次术后出现症状的中位时间59.0个月(6~126个月),差异有统计学意义(P<0.05);胆漏组中位再手术间隔时间8.0个月(5~15个月),无胆漏组间隔时间为72.0个月(24~168个月)(P<0.05)。再次手术方式:胆漏组中4例重新进行肝总管空肠吻合,2例行吻合口扩大成形术,术中未见胆道结石;无胆漏组中3例再次行肝总管空肠吻合术,15例行吻合口扩大成形术,术中发现吻合口处或肝内胆管有明显结石。术后1例发生胆漏,2例1个月内再次发生胆道感染,余21例术后恢复顺利,长期随访发现仍有5例有肝内胆管结石。结论:先天性胆管扩张症术后发生胆肠吻合口漏者早期即可出现胆道梗阻表现,应尽早再次手术治疗。

ObjectiveTo evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.MethodsThe clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.ResultsThere were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up.ConclusionsBiliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.