Right hemicolectomy combined with duodenum-jejunum Roux-en-Y anastomosis for hepatic colon carcinoma invading the duodenum:A single-center case series

BACKGROUND Hepatic colon carcinoma invading the duodenum is not common in clinical practice.Surgical treatment of colonic hepatic cancer that invades the duodenum is difficult,and the surgical risk is high.AIM To discuss the efficacy and safety of duodenum-jejunum Roux-en-Y anastomosis for the treatment of hepatic colon carcinoma invading the duodenum.METHODS From 2016 to 2020,11 patients from Panzhihua Central Hospital diagnosed with hepatic colon carcinoma were enrolled in this study.Clinical and therapeutic effects and prognostic indicators were retrospectively analyzed to determine the efficacy and safety of our surgical procedures.All patients underwent radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis.RESULTS The median tumor size was 65 mm(r50-90).Major complications(ClavienDindoI-II)occurred in 3 patients(27.3%);the average length of hospital stay was 18.09±4.21 d;and only 1 patient(9.1%)was readmitted during the 1st mo after the surgery.The 30-d mortality rate was 0%.After a median follow-up of 41 m(r7-58),the disease-free survival at 1,2,and 3 years was 90.9%,90.9%and 75.8%,respectively;the overall survival at 1,2,and 3 years was 90.9%.CONCLUSION In selected patients,radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis is clinically effective,and the complications are manageable.The surgical procedure also has an acceptable morbidity rate and mid-term survival.

A Modified Technique to Facilitate Anastomosis in Choledochal Cyst

The method of choice for the treatment of choledochal cysts in children is excision of the cyst and Roux-en-Y (RY) choledochoenterostomy. When the ratio of the diameter of the main hepatic ductus to that of the proximal RY jejunum is 1:2.5 or lower during choledochoenterostomy, end-to-end anastomosis is recommended. However, this method may cause a difference in diameters between the ends. Here we will present the technical difficulty we experienced due to the difference in diameters in end-to-end RY choledochoenterostomy and our modified anastomosis technique of anas?tomosis. This slight modification eliminated problems with anastomosis caused by a difference in the diameter of the jejunum and shortened operation time.

Magnetic compression anastomosis for reconstruction of digestive tract after total gastrectomy in beagle model

BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.

Passive-bending,short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients

AIM:To evaluate short-type-single-balloon enteroscope(SBE) with passive-bending,high-force transmission functions for endoscopic retrograde cholangiopancreatography(ERCP) in patients with Roux-en-Y anastomosis.METHODS:Short-type SBE with this technology(SIF-Y0004-V01; working length,1520 mm; channel diameter,3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis.The rate of reaching the blind end,time required to reach the blind end,diagnostic and therapeutic success rates,and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology(SIF-Y0004; working length,1520 mm; channel diameter,3.2 mm) in 25 patients.RESULTS:The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004(P = 0.59).The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004(16 min vs 24 min,P = 0.04).The diagnostic success rate was 93% with SIFY0004-V01 and 84% with SIF-Y0004(P = 0.17).The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004(P = 0.68).The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004(P = 0.50).The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group(P = 0.723).The incidence of pancreatitis was 0% in the SIFY0004-V01 group and 5.9% in the SIF-Y0004 group(P > 0.999).The incidence of gastrointestinal perforation was 2.0%(1/50) in the SIF-Y0004-V01 group and 2.9%(1/34) in the SIF-Y0004 group(P > 0.999).CONCLUSION:SIF-Y0004-V01 is useful for ERCP inpatients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.

Comparison between laparoscopic uncut Roux-en-Y and Billroth Ⅱ with Braun anastomosis after distal gastrectomy:A meta-analysis

BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration

BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.

Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM: To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000). METHODS: The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively. RESULTS: Abdominal pain,jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%).Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures.In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality. CONCLUSION: The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly.CT and ERCP were of great help in the classification of the disease.Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

Roux-en-Y choledochojejunostomy using novel magnetic compressive anastomats in canine model of obstructive jaundice

BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients.METHODS:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy.We compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations.RESULTS:The time spent on constructing the anastomosis for the study group was significantly shortened.Although no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control group.There was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study group.CONCLUSION:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.

Novel method for esophagojejunal anastomosis after laparoscopic total gastrectomy:Semi-end-to-end anastomosis

AIM: To test a new safe and simple technique for circular-stapled esophagojejunostomy in laparoscopic total gastrectomy (LATG).

Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer

AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY).

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

胆总管囊肿切除术后胆肠吻合口狭窄的腹腔镜手术处理

目的 总结胆总管囊肿切除术后胆肠吻合口狭窄再行腹腔镜手术处理的疗效。方法 回顾性分析2019年7月至2024年4月武汉大学人民医院收治的胆总管囊肿切除术后胆肠吻合口狭窄,再行腹腔镜下胆肠吻合口重建的患者资料。再次腹腔镜手术过程分为三个部分:解剖复位各相关器官,建立大口径的胆管开口、取石,重建胆肠吻合、肠肠吻合。分析胆肠吻合口重建手术的手术时间、术中出血量、肛门排气时间,以及术后住院时间、术后并发症情况。结果 根据纳排标准,本研究筛选出13例胆总管囊肿切除术后胆肠吻合口狭窄再行腹腔镜手术的患者资料。第1例患者中转开腹完成手术,其余12例均通过腹腔镜完成手术。手术时间3.5~5.0 h,平均(4.1±0.6)h;术中出血量20~150 mL,平均(61.5±41.4)mL;术后肛门排气时间2~4 d,平均(2.5±0.7)d;术后住院时间7~12 d,平均(8.8±1.9)d;术后发生胆瘘2例,无术后腹腔感染、腹腔出血、再手术、术后死亡患者。所有患者随访9~57个月,平均(32.3±15.1)个月,随访期间未见胆肠吻合口再狭窄患者,1例患者出现胆管炎表现,经保守治疗缓解。结论 胆总管囊肿切除术后胆肠吻合口狭窄再行腹腔镜手术重建胆肠吻合口,安全有效。

经脐单孔3D腔镜下肝总管-空肠改良Warren吻合术治疗儿童胆总管囊肿的效果观察

目的探究经脐单孔3D腔镜下肝总管-空肠改良Warren吻合术治疗儿童胆总管囊肿的疗效。方法选取河南省儿童医院2012年8月至2022年8月收治的90例儿童胆总管囊肿患儿,使用随机数字法分为观察组(n=45)和对照组(n=45),观察组实施经脐单孔3D腔镜下肝总管-空肠改良Warren吻合术治疗,对照组行Roux-en-Y胆肠吻合术治疗,对比两组治疗有效率、手术相关指标、肝功能及术后并发症。结果观察组治疗有效率95.56%高于对照组82.22%(P<0.05);观察组手术时间、术中出血量、术后摄食时间及住院时间均低于对照组(P<0.05);观察组肝功能指标和术后并发症发生率均低于对照组(P<0.05)。结论针对儿童胆总管囊肿患儿,采用经脐单孔3D腔镜下肝总管-空肠改良Warren吻合术治疗具有良好的效果,在提升临床疗效,改善相关手术指标和肝功能指标,减少并发症等方面具有积极意义。

Comparison of long-term quality of life between Billroth-I and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial

Background:The results of studies comparing Billroth-I(B-I)with Roux-en-Y(R-Y)reconstruction on the quality of life(QoL)are still inconsistent.The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.Methods:A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital,Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group(N=70)and R-Y group(N=70).The follow-up time points were 1,3,6,9,12,24,36,48,and 60 months after the operation.The final follow-up time was May 2019.The clinicopathological features,operative safety,postoperative recovery,long-term survival as well as QoL were compared,among which QoL score was the primary outcome.An intention-to-treat analysis was applied.Results:The baseline characteristics were comparable between the two groups.There were no statistically significant differences in terms of postoperative morbidity and mortality rates,and postoperative recovery between the two groups.Less estimated blood loss and shorter surgical duration were found in the B-I group.There were no statistically significant differences in 5-year overall survival(79%[55/70]of the B-I group vs.80%[56/70]of the R-Y group,P=0.966)and recurrence-free survival rates(79%[55/70]of the B-I group vs.78%[55/70]of the R-Y group,P=0.979)between the two groups.The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences(postoperative 1 year:85.4±13.1 vs.88.8±16.1,P=0.033;postoperative 3 year:87.3±15.2 vs.92.8±11.3,P=0.028;postoperative 5 year:90.9±13.7 vs.96.4±5.6,P=0.010),and the reflux(postoperative 3 year:8.8±12.9 vs.2.8±5.3,P=0.001;postoperative 5 year:5.1±9.8 vs.1.8±4.7,P=0.033)and epigastric pain(postoperative 1 year:11.8±12.7 vs.6.1±8.8,P=0.008;postoperative 3 year:9.4±10.6 vs.4.6±7.9,P=0.006;postoperative 5 year:6.0±8.9 vs.2.7±4.6,P=0.022)were milder in the R-Y group than those of the B-I group at the postoperative 1,3,and 5-year time points.Conclusions:Compared with B-I group,R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain,without changing survival outcomes.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-10001434.

显微镜下胆总管囊肿切除及肝管空肠Roux-en-Y吻合的应用

目的总结68例显微镜下胆总管囊肿切除、肝管空肠Roux-Y吻合术的治疗经验,探讨显微镜下胆总管囊肿切除、肝管空肠Roux-Y吻合术治疗先天性胆总管囊肿的可行性和安全性。方法回顾性分析2004年1月至2008年5月本院收治的68例先天性胆总管囊肿患儿病例资料。其中男32例,女36例,平均年龄5岁(3个月至11岁),均采用显微镜技术完成胆囊和胆总管囊肿切除,肝管空肠Roux-en-Y吻合术。结果均手术顺利,平均手术时间4(3～5.5)h,无一例术中输血。术后1周均痊愈出院,术后随访3～4个月,无并发症。结论显微镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术治疗先天性胆总管囊肿疗效可靠,镜下手术视野放大,有利于精确操作,安全性好。

Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy

AIM: To explore the mechanisms of uncut Roux-en-Y gastrojejunostomy, which is used to decrease the occurrence of Roux stasis syndrome.METHODS: The changes of myoelectric activity, mechanic motility and interstitial cells of Cajal (ICC) of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy were observed. RESULTS: When compared with the cut group, the amplitude (1.15 ± 0.15 mV vs 0.48 ± 0.06 mV, P < 0.05) and frequency (14.4 ± 1.9 cpm vs 9.5 ± 1.1 cpm, P < 0.01) of slow waves and the incidence (98.2% ± 10.4% vs 56.6% ± 6.4%, P < 0.05) and amplitude (0.58 ± 0.08 mV vs 0.23 ± 0.06 mV, P < 0.01) of spike potential of the Roux limb in the uncut group were significantly higher. The migrating myoelectric complexes (MMC) phase Ⅲ duration in the uncut group was significantly prolonged (6.5 ± 1.1 min vs 4.4 ± 0.8 min, P < 0.05), while the MMC cycle obviously shortened (42.5 ± 6.8 vs 55.3 ± 8.2 min, P < 0.05). Both gastric emptying rate (65.5% ± 7.9% vs 49.3% ± 6.8%, P < 0.01) and intestinal impelling ratio (53.4% ± 7.4% vs 32.2% ± 5.4%, P < 0.01) in the uncut group were significantly increased. The contractile force index of the isolated jejunal segment in the uncut group was significantly higher (36.8 ± 5.1 vs 15.3 ± 2.2, P < 0.01), and the expression of c-kit mRNA was significantly increased in the uncut group (0.82 ± 0.11 vs 0.35 ± 0.06, P < 0.01). CONCLUSION: Uncut Roux-en-Y gastrojejunostomymay lessen the effects of operation on myoelectric activity such as slow waves, spike potential, and MMC, decrease the impairment of gastrointestinal motility, and remarkably increase the expression of c-kit mRNA.

腹腔镜下囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿的临床效果和安全性分析

目的探讨腹腔镜下囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿的临床效果和安全性。方法回顾性分析2017年4月-2020年4月收治的胆总管囊肿患儿62例的临床资料。根据治疗方法分为对照组30例和观察组32例。对照组采用传统开腹囊肿切除术,观察组采用腹腔镜下囊肿切除联合肝总管空肠Roux-en-Y吻合术。比较2组临床疗效、围术期相关指标、肝功能指标变化情况及术后并发症发生情况。结果观察组总有效率高于对照组(P<0.05)。治疗后,2组肝功能指标水平均低于治疗前(P<0.01)。观察组术中出血量少于对照组,住院时间、肛门排气时间及腹腔引流时间短于对照组,手术时间长于对照组(P<0.01)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜下囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿临床效果较好,出血量少,可促进术后恢复,安全性高。

肝叶切除+T管引流术与胆总管空肠Roux-en-Y吻合术治疗肝内胆管结石临床对照

目的:观察肝叶切除+T管引流术、胆总管空肠Roux-en-Y吻合术治疗肝内胆管结石的临床效果。方法:选择2015年1月-2016年1月笔者所在医院接诊的131例肝内胆管结石患者为研究对象,根据术式不同将患者分为A组(65例)和B组(66例)。A组采用肝叶切除+T管引流术,B组采用胆总管空肠Roux-en-Y吻合术。所有患者术后定期复查,随访至术后2年。对比两组近远期并发症发生情况、手术前后肝功能水平。结果:A组术后结石残留、切口感染、胆漏、腹腔出血发生率分别为18.46%、3.08%、6.15%、1.54%,B组术后结石残留、切口感染、胆漏、腹腔出血发生率分别为19.70%、4.55%、4.55%、3.03%,两组比较差异均无统计学意义(P>0.05)。两组治疗后TBIL、ALT、AST水平均明显降低(P<0.05),且A组治疗后TBIL、ALT、AST水平均低于B组,差异有统计学意义(P<0.05)。两组患者术后均获得2年随访,A组结石复发、吻合口狭窄、胆管炎发生率分别为3.08%、1.54%、1.54%,均明显低于B组的13.64%、12.12%、10.61%,差异有统计学意义(P<0.05)。结论:肝叶切除+T管引流术能降低结石复发率和远期并发症发生率,可显著改善患者肝功能。

胆肠吻合口狭窄再次手术的处理

目的探讨胆肠吻合口狭窄再次手术的处理方式及预防要点。方法回顾性分析2014年1月至2022年3月无锡市第二人民医院实施再次手术治疗的13例胆肠吻合口狭窄患者的病例资料。13例中12例有胆管结石伴胆管炎发作病史,另1例为腹腔镜下胰十二指肠切除术后早期梗阻性黄疸。其中8例行开腹胆肠吻合口重建,2例行ERCP下胆肠吻合口扩张术,2例行腹腔镜下胆肠吻合口重建,1例行PTCD下胆道扩张治疗。结果本组患者经过治疗后黄疸、腹痛、胆道感染等症状均得到缓解,术后恢复良好并顺利出院。13例患者术后随访至2022年10月,其中12例患者术后无胆管炎及肝内胆管结石复发,1例合并胆管腺癌患者术后6个月因肿瘤进展死亡。结论胆管结石复发是胆肠吻合口狭窄的最常见原因。胆肠吻合口拆除重建、经皮经肝胆管介入治疗和经内镜行ERCP治疗都是治疗胆肠吻合口狭窄的重要手术方式。初次手术实施规范化胆肠吻合术的是预防狭窄的重点。一旦出现胆肠吻合口狭窄,需要制定个体化的治疗方案。

经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-Y吻合术的探讨

目的 探讨经腹腔镜行先天性胆总管囊肿切除,肝管空肠Roux-Y吻合术的可行性。方法 先天性胆总管囊肿5例,在腹腔镜监视下行胆囊穿刺胆道造影术,显示肝胆管和胰管病变,用电切或电凝切除胆总管囊肿。经脐部切口提出空肠,于腹壁外行空肠Roux-Y吻合,用5-0可吸收缝线,在腹腔镜监视下,将肝管与空肠端侧吻合。 结果 本组5例患儿手术全部成功,手术时间平均为5.1 h,(4.5h～6h)出血量20ml～50ml,吻合口直径1.0cm～1.5cm,平均住院时间6.5d,术后随访1个月～4个月,无肠粘连梗阻和吻合口狭窄发生。患儿肝功能各项指标正常。 结论 经腹腔镜行先天性胆总管囊肿切除,肝管空肠吻合术是一种安全可靠的方法,具有创伤小,视野清楚,分离缝合准确、术后恢复快等优点。