Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,Billroth II among them.Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(Billroth II:74 patients and Billroth II and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(P<0.0001).Mean daily postoperative NGT output was also statistically significantly lower in Braun group.According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group,while 9 patients who underwent Christodoulidis G et al.Billroth II and Braun compared with Billroth II WJM https://www.wjgnet.com 2 March 20,2024 Volume 14 Issue 1 Billroth II and Braun anastomosis were presented with the same conditions(P<0.05).CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux,alkaline gastritis and NGT output.

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the primary choice for removing common bile duct(CBD)stones in Billroth II anatomy patients.The recurrence of CBD stones is still a challenging problem.AIM To evaluate CBD morphology and other predictors affecting CBD stone recurrence.METHODS A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy,who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020.CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.RESULTS CBD morphology(P<0.01)and CBD diameter≥1.5 cm(odds ratio[OR]=6.15,95%confidence interval[CI]:1.87-20.24,P<0.01)were the two independent risk factors.In multivariate analysis,the recurrence rate of patients with S type was 16.79 times that of patients with straight type(OR=16.79,95%CI:4.26-66.09,P<0.01),the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type(OR=4.97,95%CI:1.42-17.38,P=0.01),and the recurrence rate of S type patients was 3.38 times that of patients with polyline type(OR=3.38,95%CI:1.07-10.72,P=0.04).CONCLUSION CBD morphology,especially S type and polyline type,is associated with increased recurrence of CBD stones in Billroth II anatomy patients.

Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction:An esophagogastroduodenoscope or a colonoscope?

BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly performed.However,the procedures are difficult,and the techniques and strategies have not been defined.AIM To reveal the appropriate scope for ERCP in B-II patients.METHODS Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II gastrectomy.These cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS groups.RESULTS The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.

Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth Ⅱ gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy.However,there has been a paucity of comparative studies regarding ERCP in Billroth Ⅱ gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations.This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth Ⅱ gastrectomy patients.AIM To systematically review the literature regarding ERCP in Billroth Ⅱ gastrectomy patients.METHODS A systematic review was performed on the literature published between May 1975 and January 2019.The following electronic databases were searched:PubMed,EMBASE,and Cochrane Library.The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.RESULTS A total of 43 studies involving 2669 patients were included.The study designs were 36(83.7%)retrospective cohort studies,4(9.3%)retrospective comparative studies,2(4.7%)prospective comparative studies,and 1(2.3%)prospective cohort study.Of a total of 2669 patients,there were 1432 cases(55.6%)of sideviewing endoscopy,664(25.8%)cases of forward-viewing endoscopy,171(6.6%)cases of balloon-assisted enteroscopy,169(6.6%)cases of anterior obliqueviewing endoscopy,64(2.5%)cases of dual-lumen endoscopy,31(1.2%)cases of colonoscopy,and 14(0.5%)cases of multiple bending endoscopy.The overall success rate of afferent loop intubation was 91.3%(2437/2669),and the overall success rate of selective cannulation was 87.9%(2346/2437).A total of 195 cases(7.3%)of adverse events occurred.The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows:side-viewing endoscopy 98.2%and 95.3%;forward-viewing endoscopy 97.4%and 95.2%;balloon-assisted enteroscopy 95.4%and 97.5%;oblique-viewing endoscopy 94.1%and 97.5%;and dual-lumen endoscopy 82.8%and 100%,respectively.The rate of bowel perforation was slightly higher in side-viewing endoscopy(3.6%)and balloon-assisted enteroscopy(4.1%)compared with forward-viewing endoscopy(1.7%)and anterior oblique-viewing endoscopy(1.2%).Mortality only occurred in side-viewing endoscopy(n=9,0.6%).CONCLUSION The performance of ERCP in the Billroth Ⅱ gastrectomy population has been improving with choice of various type of endoscope and sphincter management.More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth Ⅱ gastrectomy patients.

远端胃大部切除术中BillrothⅡ+Braun吻合对进展期胃癌术后营养状况及并发症的影响

目的探讨BillrothⅡ+Braun吻合应用于远端胃大部切除术中对进展期胃癌患者的营养状况及并发症的影响。方法选择2017年1月至2022年12月在南京医科大学第四附属医院接受远端胃大部切除术且完成6个月随访的95例进展期胃癌患者作为研究对象,将其中采用BillrothⅡ+Braun吻合的45例患者作为观察组;采用BillrothⅡ吻合的50例患者作为对照组。比较两组患者手术时间、术中出血量、术后下床活动时间、首次肛门排气时间、住院时间、并发症发生情况及术后3、6个月血清总蛋白、白蛋白及血红蛋白水平。结果两组患者手术时间、术中出血量、术后下床活动时间、首次肛门排气时间及住院时间比较,差异无统计学意义(P>0.05);观察组患者的术后3、6个月血清总蛋白、白蛋白、血红蛋白水平均显著高于对照组(P<0.05);观察组患者近期并发症及远期并发症发生率均显著低于对照组(P<0.05)。结论应用BillrothⅡ+Braun吻合可有效改善进展期胃癌远端胃大部切除术患者术后营养状况,降低术后近期及远期并发症发生率。

改良BillrothⅡ+Brown吻合与U-RY吻合在腹腔镜远端胃癌根治术中的应用效果比较

目的对比改良BillrothⅡ+Brown吻合与U-RY吻合在腹腔镜远端胃癌根治术中的临床效果。方法回顾性分析2022年3月至2023年4月于信阳市肿瘤医院肿瘤外科行腹腔镜远端胃癌根治术的123例胃癌患者临床资料,根据吻合术式分为两组,将61例采用U-RY吻合术的患者归为U-RY吻合组,62例采用改良BillrothⅡ+Brown吻合术的患者纳入改良BillrothⅡ+Brown吻合组。比较两组围手术期指标、胃肠功能恢复情况、复发率及并发症发生情况。结果改良BillrothⅡ+Brown吻合组住院时间及肠鸣音恢复时间较U-RY吻合组短(P<0.05)。两组患者术后1 a复发率比较,差异无统计学意义(P>0.05)。改良BillrothⅡ+Brown吻合组术后远期并发症发生率低于U-RY吻合组(P<0.05)。结论与U-RY吻合术相比,腹腔镜远端胃癌根治术中采用改良BillrothⅡ+Brown吻合的效果更好,可缩短患者住院时间及肠鸣音恢复时间,降低远期并发症发生风险。

腹腔镜下胃切除术中BillrothⅡ式伴布朗式吻合术的应用效果研究

目的:分析腹腔镜下胃切除术中BillrothⅡ式伴布朗式吻合术的应用效果。方法:研究开展时间为2020年8月至2022年7月,从黔东南州人民医院收治的胃癌患者中随机筛选84例进行研究,随机分为两组,各42例。两组均采取腹腔镜下胃切除术治疗,其中对照组术中采取BillrothⅡ式吻合操作,观察组术中采取BillrothⅡ式伴布朗式吻合操作,对比两组的手术及术后恢复指标、术后早期并发症发生率及远期疗效。结果:两组的手术时间、消化道重建耗时、术中出血量、术后排气时间、住院时间相比差异不显著(P>0.05)。在术后早期并发症方面,观察组腹泻、反流、肠梗阻的发生率均显著低于对照组(P<0.05),两组吻合口瘘、胃瘫综合征的发生率相比差异不显著(P>0.05)。术后6个月,观察组中Visick分级Ⅰ级患者的占比显著高于对照组(P<0.05),两组中Visick分级Ⅱ级、Ⅲ级、Ⅳ级患者的占比相比差异不显著(P>0.05)。结论:在腹腔镜下胃切除术中,采取BillrothⅡ式伴布朗式吻合术能显著降低患者术后腹泻、反流、肠梗阻的发生率,提高远期疗效,且不会增加手术难度,对术中出血量及手术时间影响不大。

入口上提的改良Billroth Ⅱ+Brown吻合在腹腔镜远端胃癌根治术中的应用价值

目的:比较入口上提的改良BillrothⅡ+Brown吻合术与传统BillrothⅡ+Brown吻合术在全腔镜下远端胃癌根治性切除术中的临床应用价值。方法:回顾分析2020年1月至2022年3月收治的182例胃癌患者的临床资料,其中92例术中行入口上提的改良BillrothⅡ+Brown吻合术(观察组),90例行传统BillrothⅡ+Brown吻合术(对照组),对比分析两组患者术中情况(包括手术时间、消化道重建时间、术中出血量、淋巴结清扫数量)、术后早期肠道功能恢复情况(包括术后首次排气时间及首次下床活动时间)、并发症(包括术后十二指肠残端漏,输入袢、输出袢梗阻等)及术后半年内随访相关指标(包括胆汁反流、反流性胃炎等)。结果:两组手术时间、消化道重建时间、术中出血量、淋巴结清扫数量差异无统计学意义,观察组术后早期排气时间[(2.60±0.70)d vs.(3.10±1.20)d]、术后首次下床活动时间[(3.20±1.50)d vs.(5.10±1.30)d]早于对照组(P<0.05)。在术后并发症方面,观察组输入袢梗阻发生率(1.09%vs.7.78%)、总并发症发生率(6.52%vs.12.22%)低于对照组(P<0.05),两组在吻合口漏、输出袢梗阻等方面差异无统计学意义。在远期并发症方面,对照组胆汁反流、胃炎更严重,差异有统计学意义,两组Clavien-Dindo术后分级差异无统计学意义。结论:入口上提的改良BillrothⅡ+Brown吻合方式是安全、可行的,在术后肠道功能早期恢复、减少术后并发症、改善术后生活质量方面较传统吻合方式更具优势,具有较高的临床应用价值,值得推广。

腹腔镜远端胃癌根治BillrothⅠ式吻合术后胃瘫综合征相关因素分析

目的探讨腹腔镜远端胃癌根治BillrothⅠ式吻合术后胃瘫综合征(PGS)的相关因素。方法回顾性分析2018-01—2023-01中国人民解放军联勤保障部队第九八八医院普通外科行腹腔镜远端胃癌根治BillrothⅠ式吻合术患者的临床资料。选取30例术后发生PGS的患者为PGS组;另收集同期术后未发生PGS的30例患者为非PGS组,收集患者的临床资料,经单因素与多因素分析术后发生PGS的相关因素。结果单因素分析结果显示,术前低蛋白血症、幽门梗阻,围术期空腹血糖(FBG)水平与PGS相关(P<0.05);性别、文化程度、年龄、BMI、吸烟史、饮酒史、手术时间、术中出血量,以及术后自控镇痛和腹腔并发症与PGS无关(P>0.05)。Logistics回归分析显示,术前伴有低蛋白血症、术前伴有幽门梗阻,以及围术期FBG水平较高是腹腔镜远端胃癌根治BillrothⅠ式吻合术后患者发生PGS的影响因素(OR>1,P<0.05)。结论术前伴有低蛋白血症和幽门梗阻、围术期FBG水平较高均是腹腔镜远端胃癌根治BillrothⅠ式吻合术后发生PGS的影响因素。

Billroth I-ART吻合在全腹腔镜远端胃癌根治术中安全性及疗效研究

目的探究全腹腔镜远端胃癌根治术BillrothⅠ-ART吻合的安全性及术后近期疗效。方法回顾性分析首都医科大学附属北京友谊医院81例原发性胃癌病人行全腹腔镜ART吻合的临床资料及随访资料。结果手术时间(226.2±46.4)min,吻合时间(11.7±3.6)min,术中出血量50[四分位数间距(QR)=50]mL,所有病人均R0切除。首次下床时间1(1)d,首次排气时间为3(QR=1.5)d,拔除胃管时间2(QR=2)d,首次进食时间3(QR=1)d,首次进流食时间5(QR=2)d,术后住院时间7(QR=1)d。术后30 d内无严重并发症及死亡。随访结果中,术后6个月的倾倒综合征发生率为6.25%,反流症状发生率为16.25%。在EORTC QLQ-C30及QLQ-STO22量表中,情绪和社会功能与其他功能领域相比较差,疲劳、腹泻、经济困难、焦虑与其他症状领域相比较差。术后1年随访中,胃炎占52.3%,吻合口炎占15.9%,反流性食管炎占6.8%,胆汁反流占6.8%,胃潴留占15.9%。结论全腹腔镜ART吻合是安全可行的,在吻合口相关并发症和近期疗效方面结果显著。

胃癌Billroth Ⅱ式胃切除术对合并2型糖尿病患者的治疗价值

目的探讨胃癌BillrothⅡ式胃切除术对合并2型糖尿病患者糖代谢的影响。方法回顾性观察7例体重指数(BMI)<35kg/m2合并2型糖尿病的病人因胃癌接受BillrothⅡ式胃切除手术前后血糖控制情况以及糖尿病治疗的变化。结果7例均成功完成了根治性BillrothⅡ式胃切除术,4例行腹腔镜手术,3例行开腹手术。术后未发生严重并发症。术前空腹血糖(FPG)6.6～9.0mmol/L,平均8.1mmol/L;糖化血红蛋白(HbA1c)6.8%～9.5%,平均7·8%。术后1～8个月复查FPG4.8～7.9mmol/L,平均6.4mmol/L;HbA1c5.5%～7.2%,平均6.3%。据美国糖尿病协会(ADA)糖尿病疗效判断标准,4例治愈,3例改善。结论胃癌BillrothⅡ式胃切除术可治疗胃癌患者合并的2型糖尿病。

快速康复外科在远端胃癌BillrothI式手术中的临床应用

目的探讨应用快速康复外科方案和传统方法在远端胃癌Billroth I式手术中治疗的效果。方法随机选取2009年1月至2010年12月远端胃癌行Billroth I式吻合患者74例,分为传统手术组40例和快速康复组34例,比较两组患者术后住院时间、肛门排气时间、咽喉疼痛、急性胃扩张、切口及肺部感染、吻合口瘘等并发症发生率。结果两组患者均痊愈出院。快速康复组术后患者住院时间及首次肛门排气时间较对照组缩短,咽痛明显减少(P<0.05),但两组患者出现急性胃扩张、切口及肺部感染、吻合口瘘发生率差异无统计学意义(P>0.05),发生急性胃扩张需重置胃肠减压管和禁食病例差异无统计学意义(P>0.05)。两组C-反应蛋白(CRP)及血糖指标术后均升高,快速康复组各项指标升高水平较对照组低,差异具有统计学意义(P<0.05)。结论对于远端胃癌Billroth I式患者,快速康复外科治疗方案是安全、有效的围手术期处理方案。

Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis

AIM: To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth?I?(B-I) anastomosis after distal gastrectomy (DG) for gastric cancer.METHODS: A literature search was performed to identify studies comparing R-Y with B-I?after DG for gastric cancer from January 1990 to November 2012 in Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either ?xed or random effects model. Operative outcomes such as operation time, intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture, bile re?ux, remnant gastritis, re?ux esophagitis, dumping symptoms, delayed gastric emptying and hospital stay were the main outcomes assessed. Meta-analyses were performed using RevMan 5.0 software (Cochrane library).RESULTS: Four randomized controlled trials (RCTs) and 9 non-randomized observational clinical studies (OCS) involving 478 and 1402 patients respectively were included. Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile re?ux (OR 0.04, 95%CI: 0.01, 0.14; P < 0.00?001) and remnant gastritis (OR 0.43, 95%CI: 0.28, 0.66; P = 0.0001), however needing a longer operation time (WMD 40.02, 95%CI: 13.93, 66.11; P = 0.003). Meta-analysis of OCS also revealed R-Y reconstruction had a lower incidence of bile re?ux (OR 0.21, 95%CI: 0.08, 0.54; P = 0.001), remnant gastritis (OR 0.18, 95%CI: 0.11, 0.29; P < 0.00?001) and re?ux esophagitis (OR 0.48, 95%CI: 0.26, 0.89; P = 0.02). However, this reconstruction method was found to be associated with a longer operation time (WMD 31.30, 95%CI: 12.99, 49.60; P = 0.0008).CONCLUSION: This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I?reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same.

胃切除后Roux-en-Y与Billroth重建术式比较

目的:探讨胃大部切除术后常用胃肠重建术式的优劣。方法:回顾性分析117例胃切除术后消化道重建患者的资料。结果:45例Roux-en-Y胃肠重建者无反流性胃炎,无十二指肠残端瘘,预防远期残胃癌极其关键;仅有2例出现滞留综合征。72例Billroth胃肠重建术后反流所致的胃黏膜损害和碱性反流性胃炎,远期残胃癌及其他并发症至今尚无可靠而有效的预防方法。结论:胃切除术后的消化道重建如不能进行Billroth-I式,Roux-en-Y方式应是另一较好的消化道重建术式。

Randomized controlled trial of uncut Roux-en-Y vs Billroth Ⅱ reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and Billroth II group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with Billroth II reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

小切口胆管十二指肠残端吻合治疗胃BillrothⅡ术后胆管结石

目的探讨胃BillrothⅡ式术后胆管结石的诊治方法。方法先进行ERCP检查明确胆管结石,再采用右肋缘下5～6 cm微小切口开腹做胆管十二指肠残端吻合术治疗。结果 36例小切口胆总管十二指肠残端吻合术顺利,无并发症。结论胃BillrothⅡ式术后胆管结石ERCP成功率较高并有实用价值,进行小切口胆总管十二指肠残端吻合术临床疗效好。

非离断式Roux-en-Y吻合与BillrothⅡ式吻合在腹腔镜远端胃癌根治术中比较的meta分析

目的:系统评价非离断式Roux-en-Y吻合术与BillrothⅡ式吻合术在腹腔镜远端胃癌根治术中的临床疗效。方法:检索PubMed、Embase、Cochrane图书馆、CBM、VIP、CNKI及万方数据等数据库,收集国内外公开发表的关于两种消化道重建方式在腹腔镜远端胃癌根治术中对比的临床研究,检索时限为建库至2019年10月。对纳入的文献进行资料提取与质量评价,应用RevMan 5.3软件进行meta分析。结果:最终纳入9项研究,共900例患者。meta分析结果显示,在腹腔镜远端胃癌根治术中应用非离断式Roux-en-Y吻合术后排气时间、首次进流质饮食时间及住院时间短(WMD=-0.29,95%CI-0.44^-0.13,P=0.0002;WMD=-0.41,95%CI-0.66^-0.15,P=0.002;WMD=-0.85,95%CI-1.23^-0.47,P<0.00001),术后近期胃排空障碍、远期胆汁反流及反流性胃炎发生率较低(OR=0.41,95%CI 0.19~0.88,P=0.02;OR=0.06,95%CI 0.02~0.19,P<0.00001;OR=0.14,95%CI 0.05~0.42,P=0.0003),两组手术时间、术中消化道重建时间、术中出血量及远期营养状况差异无统计学意义。结论:腹腔镜远端胃癌根治术中应用非离断式Roux-en-Y吻合术是安全、可行的,具有较好的近、远期临床疗效,可有效降低术后近期胃排空障碍、远期胆汁反流及反流性胃炎发生率,临床应用具有一定优势。

胃BillrothⅡ式术后肝胆管结石219例诊治分析

目的探讨胃BillrothⅡ式术后肝胆管结石的临床特点。方法胃BillrothⅡ式术后肝胆管结石患者219例中,130例单一抗感染治疗;74例进行逆行胰胆管造影(ERCP)后,34例经内镜乳头括约肌切开(EST)、4例经内镜乳头气囊扩张术(EPBD)取石、36例行小切口胆总管十二指肠残端吻合术;15例急性重症胆管炎手术引流。结果全组137例ERCP成功109(79.6%)例,失败28(20.4%)例。130例单一抗感染治疗好转出院;38例EST取石治疗,成功31(81.6%)例,并发消化道大出血4例;36例小切口胆总管十二指肠残端吻合术和15例急诊手术者均顺利治愈出院。结论胃BillrothⅡ式术后肝胆管结石急性期多数保守治疗能缓解,施行EST治疗成功率较高并有临床实用价值,进行小切口胆总管十二指肠残端吻合术临床效果较好。

ERCP for patients who have undergone Billroth Ⅱ gastroenterostomy and Braun anastomosis

Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomoses. There are currently no reports describing the preferred enterography route for cannulation in these patients. We first review the patient&#x02019;s previous surgery records, which most often indicate that the efferent loop is at the greater curvature of the stomach. We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the &#x0201c;lower entrance&#x0201d; at the site of the gastrojejunal anastomosis, along the efferent loop, and through the &#x0201c;middle entrance&#x0201d; at the site of the Braun anastomosis to reach the papilla of Vater. Ten patients who had each undergone Billroth II gastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study. The overall success rate of enterography was 90% for the patients who had undergone Billroth II gastroenterostomy and Braun anastomosis, and the therapeutic success rate was 80%. We believe that this enterography route for ERCP is optimal for a patient who has had Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.