先天性胆管囊状扩张症术后胆肠吻合口狭窄再次手术分析

Reoperation of biliary-enteric anastomotic stricture after surgery for congenital choledochal cysts

目的分析先天性胆管囊状扩张症术后胆肠吻合口狭窄的原因。方法回顾性分析2014年1月至2018年6月湖南省人民医院肝胆外科收治的先天性胆管囊状扩张症术后胆肠吻合口狭窄的28例患者的临床及随访资料。该组患者吻合口狭窄距上次手术0.2~25年,平均15年。结果26例为良性狭窄,2例癌变。26例重新行胆管空肠Roux-en-Y吻合,其中合并肝叶切除8例。2例因吻合口癌变仅行胆道外引流术。无住院死亡,无严重并发症。术后随访时间6~67个月,2例肿瘤患者于半年内死亡,其余患者均未发生远期并发症。结论胆肠吻合口狭窄是先天性胆管囊状扩张症术后远期严重的并发症之一,宽敞、无张力的胆肠吻合可能有助于减少远期吻合口狭窄。

Objective To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods These 28 patients underwent salvage operation on an average 15 years(0.2-25 years)after initial surgeries at the Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results In 26 patients the biliary-enteric anastomotic stenosis was benign,and in 2 the stricture was caused by cancerration.In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct.In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis,an external drainage was adopted.There were no inhospital deaths,and no serious complications.The postoperative follow-up time was 6-67 months.Two cancerated patients died within half a year,and the remaining patients had no long-term complications.Conclusions Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts.Hence a wide,tension free biliary-enteric anastomosis performed by a experienced hand is necessary.