先天性胆总管囊肿切除短段空肠代胆道手术——临床和实验研究

Artificial Spur Valve Antireflux Mechanism in Choledochus Cyst Excision-A Clinical and Experimental Study

囊肿切除胆肠Roux-γ吻合术为治疗先天性胆总管囊肿通用的手术.但该手术存在三个问题:①全囊切除损伤面广、出血多、污染面大;②Roux-γ防返流空肠袢较长,本身迂益,易致胆汁淤滞及梗阻,增加感染及结石形成的机会;③胆汁引流至空肠改变了十二指肠正常生理环境.为此,我们进行了改进:①将囊肿之游离部分全层切除,配合小部分后壁内层切除,缩小了剥离面;②在肝总管和十二指肠之间,间置一短段空肠代胆道,使胆汁直接引流至十二指肠;③加用矩形瓣防止返流(1).称之为'囊肿切除短段空肠代胆道'手术.

The authors designed a new operation,artificial antireflux spur valve, to treat conge nital choledochal cysts,which was performed in 31 cases with satisfactory results.Good antireflux effect was achieved during and after operation when checked on table and after.All the 22 followed-up cases were uneventful.The main points of the procedure include:1.excision of the free part of the cyst wall and the gall bladder by Bovle in full thickness and peeling off of the mucosa only of the rest part which adheres to portal vessel so as to lessen the oozing surface.2.taking short jejunal segment of 10 cm with pedicle between hepatic duct and duodenum to avoid redundan cy.3.construction of a spar valve at the duodenal anastomosis to prevent reflux.54 dogs were used in a series of animal experi ments with the results as follows:1.optimal length of spur-valve being 5 cm which will maintain a normal intra-biliary pressure(20 mmHg)to prevent reflux on normal peristal sis, and will keep close against a reflux pres sure(41 mmHg)to prevent reflux from intestinal obstruction.2.the anti-reflux effect of the spur showing some decrease one month after operation,but recovering its function after the 2nd month.3.barium study showing full reflux filling into a con ventional 40 cm Roux-Y limb,but no more than 5 cm reflux into a spur valve bile duct.4.postoperative gastric analysis being normal.5.autopsy revealing no food particles or inflammation in the artificial bile duct,nor ulcers in stomach or duodenum,However the authors emphasize that to observe long-term results a large number of cases should be followed up for a long period of time.