返流性胆管炎与胆肠吻合术

Reversion cholangitis and cholangioenterostomy

目的 探讨返流性胆管炎的病因、治疗与胆肠吻合术的关系。方法 回顾性研究 74例返流性胆管炎的病因、病理、治疗方法和效果。结果 胆道返流的主要原因为胆总管十二指肠吻合(19例 )或Oddi括约肌切开 (2例 )术后和Oddi括约肌松弛 ,失去抗返流功能 (5 3例 )。反复胆道返流可导致肝胆系统急慢性炎症、结石再发。行胆管空肠Roux en Y型吻合术 38例和胃部分切除胃空肠吻合术 2 0例 ,观察 6年半的优良率为 83%。结论 反复胆道返流与胆管炎和结石再发密切相关 ,通过外科手术消除或减轻胆道返流因素 ,可获得良好的效果。

Objective To investigate the reasons and treatment of reversion cholangitis and explore its relation to cholangioenterostomy. Methods The reasons, pathology, treatment and outcome of reversion cholangitis in 74 patients were retrospectively analyzed. Results The reasons for reversion cholangitis included: choledochoduodenostomy (19 cases), post sphincterotomy of Oddi (2 cases) and dysfunction of anti reversion caused by the slacking of Oddi's sphincter (53 cases). Repetitive cholangio reversion resulted in acute or chronic inflammation and the recurrence of calculus in hepatic and cholangio bile duct system. Roux en Y cholangiojejunostomy was performed in 38 cases and partial gastrectomy and gastrojejunostomy were done in 38 cases. The follow up study for 6 5 years in all the patients showed that the outcome was good (curative rate=83%). Conclusions Repetitive cholangio reversion is closely related to cholangitis and recurrence of calculus in hepatic and cholangio bile duct system. Elimination or reduction of factors for cholangio reversion through surgical means is the best choice for treatment of reversion cholangitis.