锥形瓣加强胆管空肠Y型吻合术后抗返流

A conic valve strengthen the antireflux effect of choledochojejunostomy

目的 探讨锥形瓣预防Roux -en -Y胆肠吻合术 (CJ)术后返流性胆管炎的可行性及临床疗效。方法 在CJ术同时施行锥形瓣成形术 86例 ,其中男性 33例 ,女性 5 3例 ;平均年龄 38岁。严格遵循CJ适应证及手术原则。将胆支空肠预作Y型吻合、系膜缘侧 1.5cm处向对系膜缘侧前后肠壁作等腰三角形切除 ,近侧游离断端封闭 ,远侧游离断端与胃十二指肠支空肠作端端吻合 ,两支空肠并行固定。胆支空肠下端斜形断面与胃十二指肠支空肠肠壁形成的斜形隔和胆支空肠下端开口处空肠粘膜皱襞形成锥形瓣。术后因合并症死亡 2例 ,其余 84例术后通过碘液胆管造影、钡餐胃肠道造影、随访返流性胆管炎临床表现 ,观察锥形瓣抗返流情况。结果 锥形瓣引流通畅、排空好、无返流 ,无返流性胆管炎临床表现。结论 锥形瓣手术安全 ,无直接手术并发症 ,抗返流效果确切 。

Objective To investigate the feasibility and clinical effect of conic valve on preventing refluxant cholangitis after Roux-en-Y choledochojejunostomy (CJ). Methods 86 patients with average age of 38 were performed conic valvoplasty,including 33 male and 53 female. To perform Y-typed anastomose, the jejunum of the biliary branch was refected 1.5 cm from mesenteric border as isosceles-triangle shape to the antimesenteric border. Then the near dissociate broken side to block out, between the far side and the jejunum of the gastroduodenal branch perform termino-terminal anastomosis was performed. The two jejunumal branchs are fastened parallely. The conic valve is composed of the inclined broken side and the mucosal plica of the lower end of jejunum and the inclined partion formed by jejunum. 2 patients died of complications, the antireflux effect was observed by iodiphin graphy of bile duct, barium meal graphy of stamoch and intestine and the clinical manifestation in other patients. Results The conic valve excrete fluently,drainage freely and has no reflux. Conclusions The conic valvoplasty has the advantage of safty and no direct complications. It has powerful antireflux effect and can shorten the length of jejunum of biliary branch.