腹腔镜手术治疗微创胰十二指肠切除术后胆肠吻合口狭窄7例报道

Redo laparoscopic operations for choledochojejunostomy stenosis after minimally invasive pancreaticoduodenectomy: a report of 7 patients

目的:探讨腹腔镜手术治疗微创胰十二指肠切除术后胆肠吻合口狭窄的可行性及安全性。方法:回顾性分析2019年8月至2021年7月浙江省人民医院胃肠胰外科收治的微创胰十二指肠切除术后发生胆肠吻合口狭窄再次行腹腔镜手术治疗的7例患者临床资料,其中男性3例,女性4例,年龄(41.7±4.3)岁,年龄范围27~54岁。分析再次手术时间、术中出血量、术后并发症,门诊复查或电话随访再狭窄情况。结果:首次术后出现吻合口狭窄的时间间隔范围3~20个月,中位数9个月。7例患者胆肠吻合口狭窄均行腹腔镜手术治疗,其中5例行腹腔镜胆肠吻合口切除重建;另2例行腹腔镜原吻合口切开,取尽合并的肝内胆管结石再吻合。胆肠吻合口重建手术时间范围150~350 min,中位数180 min,术后住院时间范围5~21 d,中位数6 d,术中出血量范围20~300 ml,中位数50 ml,无术中输血。术后1例患者出现B级胆漏,穿刺引流后好转。其余患者未发生严重并发症,无围手术期死亡患者。7例患者均获随访,术后随访时间范围1~23个月,中位数8个月,无胆肠吻合口再狭窄。结论:对于微创胰十二指肠切除术后胆肠吻合口狭窄的患者,再次腹腔镜手术治疗可作为一种有效的选择。

Objective To study the feasibility and safety of redo laparoscopic operations for choledochojejunostomy stenosis after minimally invasive pancreaticoduodenectomy.Methods The clinical data of 7 patients with choledochojejunostomy stenosis which developed after minimally invasive pancreaticoduodenectomy who were treated with redo laparoscopic surgery from August 2019 to July 2021 at the Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People's Hospital were retrospectively studied.There were 3 males and 4 females,with the age of(41.7±4.3)(ranged 27 to 54)years.The timing of reoperation,intraoperative blood loss,and postoperative complications were analyzed.An anastomotic restenosis was looked for on followed-up by outpatient interviews or phone calls.Results The time interval of between diagnosis of the first postoperative anastomotic stenosis and surgery was 3-20 months,with a median of 9 months.Of the 7 patients,5 patients underwent laparoscopic biliary anastomotic resection and reconstruction,and the remaining 2 patients underwent laparoscopic exploration of the anastomosis,removal of intrahepatic bile duct stones,and re-anastomosis.The median operative time was 180(150-350)minutes.The median postoperative hospital stay was 6(ranged 5 to 21)days.The intraoperative blood loss was 50(ranged 20 to 300)ml.There was no intraoperative blood transfusion.One patient developed grade B biliary leakage after the surgery,improved with puncture and drainage.The remaining patients had no serious complications.There was no mortality.The median follow-up was 8(ranged 1 to 23)months,during which no recurrence of biliary anastomotic stenosis occurred in all these patients.Conclusion For patients with biliary anastomotic stenosis after minimally invasive pancreaticoduodenectomy,redo laparoscopic operations offered an alternative treatment option with satisfactory outcomes.