先天性胆总管囊肿切除后不同胆道重建术的疗效

目的 评价先天性胆总管囊肿切除后不同胆道重建术的疗效。方法 对行囊肿切除，肝总管空肠Roux-en-Y吻合重建胆道的106例先天性胆道囊肿病例进行回顾性分析和随访复查。结果 在106例重建的胆道中，胆支空肠袢套叠瓣成形37例，矩形瓣成形21例，未做抗反流瓣48例。获随访61例，平均4．82年。无1例发生吻合口狭窄，逆行性胆感染4例（矩形瓣组1例，未做抗反流瓣组3例），2例再手术并于胆支空肠袢套叠瓣成形术后症状消失；偶有腹痛症状8例，其中未做抗反流瓣组5例，矩形瓣成形组2例，套叠瓣成形组1例。结论 在先天性胆总管囊肿切除后胆道重建中，肝总管空肠Roux-en-Y吻合加胆支空肠袢套叠成形术胆道生理，能有效预防术后胆道反流和吻合口狭窄。     

先天性胆总管囊肿76例疗效观察

目的:探讨先天性胆总管囊肿的诊治与疗效。方法:本组76例,分别采用囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术38例;囊肿切除短段空肠代胆道术38例。术后进行3个月-5年的随访,得出优、良、差三种不同结果。结果:治愈出院74例,死亡2例。随访62例,占84％。囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术随访30例:优11例,良13例,差6例,优良率占80％。囊肿切除短段空肠代胆道加矩形瓣防返流术随访32例:优18例,良14例,优良率100％。结论:囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术术后并发症多,包括吻合口狭窄,逆行感染,复发性胆管炎等,疗效不理想;囊肿切除短段空肠代胆道术虽手术操作复杂,但主要优点是恢复了胆汁的生理通道,手术恢复后疗效相当满意。     

先天性胆总管囊肿的治疗

目的:研究囊肿切除肝总管空肠Roux-Y吻合术治疗先天性胆总管囊肿的随访结果和疗效评价。方法:本组18例,男5例,女13例,均采用囊肿切除肝总管空肠吻合术,部分加矩形瓣及其他抗返流手术。结果:18例均痊愈出院,随访6月～2年,全部患儿均未出现胆管炎及腹痛症状,肝功能正常。2例术后1年有钡剂返流,均属于未行抗返流手术者。结论:囊肿切除,肝总管空肠吻合加抗返流术是治疗先天性胆总管囊肿的一种较完善的手术。     

31例先天性胆总管囊肿的手术治疗

本组31例先天性胆总管囊肿病人均采用外科手术治疗，切除胆总管囊肿，用2种方法重建胆道（Roux-Y吻合术与间置空肠代胆道术），18例Roux-Y吻合术后并发粘连性肠梗阻2例，13例间置空肠代胆道加矩形瓣，术后恢复顺利，随访27例，平均2年6月（3月－6年），未发生并发症，胆总管囊肿切除，Roux-Y吻合术与间置空肠代胆道术是先天性胆总管囊肿切除后胆道重建适宜选用的手术。     

囊肿切除空肠间置加矩形瓣术治疗178例胆总管囊肿远期疗效的评价

目的 对胆总管囊肿采用囊肿切除,空肠间置加矩形瓣术式远期疗效作一评价。方法 对我院178例先天性胆总管囊肿采用囊肿切除,空肠间置加矩形瓣术后不同时期进行随访。复查重点：（1）上消化道造影,观察有无返流及返流程度。（2）因保守治疗无效,被迫再次手术。结果 随访142例,占79．8％。综合评价结果：症状消失21例,占4．8％;轻度异常26例,占8．3％;中度异常51例,占35．9％;严重异常28例,占9．0％;再手术16例,占11．3％／。结论 该术式的优点：近1－2年内有一定的抗返流作用,切除囊肿,预防癌变,重建胆道,合乎生理要求;不足之处：远期无抗返流作用,可发生胆道逆行感染、胆道梗阻、甚至穿孔、发生结石的患儿有逐年增加的趋势。     

先天性胆总管囊肿的手术体会

目的：探讨胆总管囊肿手术切除和重建胆道的手术方法。方法：总结近5年来应用本术式的临床经验，回顾观察术后疗效、生活质量。结果：随访发现，均无胆道感染症状发作，小儿营养发育良好，X线钡餐透视动态观察，空肠—空肠半周同步吻合加桥袢空肠人工套叠双重抗返流效果良好。结论：小儿与成人均可接受本术式治疗，其即可达到切除胆总管囊肿的目的，又基本上防止了重建胆道术后胆肠吻合口狭窄、逆行感染等并发症的发生。     

先天性胆总管囊肿再次手术的原因及处理对策

目的探讨先天性胆总管囊肿再次手术的原因及处理对策。方法对15例先天性胆总管囊肿患者的临床资料及再手术方法和疗效进行总结分析。结果前次手术方式为胆囊切除、胆总管切开取石者8例;胆总管囊肿空肠侧侧或侧端吻合术者5例;胆总管囊肿十二指肠侧侧吻合术、左肝外叶切除术者1例;行胆总管囊肿切除、肝总管空肠端端内引流术者1例。前次手术并发症为胆管结石形成14例,胆道感染10例,癌变1例。再次手术以切除囊肿、肝管空肠Roux-Y吻合术为主,术后随访平均(41.5±30.9)个月,随访期间发生胆道感染1例,无吻合口狭窄或结石形成等并发症发生。结论胆总管囊肿首次术式选择不当及诊断失误出现的多种并发症是导致再手术的主要原因,囊肿切除、肝管空肠Roux-Y吻合术是再手术的基本术式。     

先天性胆总管囊性扩张症的外科治疗(附145例报告)

目的　总结我院 3 5年外科治疗先天性胆总管囊性扩张症的经验。方法　对 1964～ 1999年共收治的 15 2例先天性胆总管囊性扩张症中接受手术治疗的 14 5例进行回顾性分析和随访。结果　 15 2例中未手术 7例 ,死亡 1例。手术治疗 14 5例 ,死亡 6例。 1岁以内出现症状、发生肝硬变和死亡例数比 1岁以上组高 (P<0 .0 5 )。单纯囊肿内引流术3 9例 (囊肿十二指肠吻合 5例、囊肿空肠Roux Y吻合 3 3例、囊肿胆囊吻合 1例 ) ,囊肿切除胆肠Roux Y吻合重建胆道10 6例 (胆支空肠袢套叠瓣或矩形瓣成形分别为 3 7例和 2 1例 ,48例未作抗返流瓣 )。获访 77例 ,平均 4.68年。获访病例生长发育良好。结论　该病早期手术肝损伤可逆转 ,预后良好 ,只要患儿能耐受应尽早选择囊肿切除胆肠Roux Y吻合套叠瓣成形胆道重建术     

肝管十二指肠吻合粘膜乳头成型术的临床与实验研究

目的验证肝管十二指肠吻合粘膜乳头成型术的抗返流作用.方法16只犬被分为3组A组行肝管十二指肠吻合粘膜乳头成型术;B组行胆囊空肠Roux-en-Y吻合术胆支肠管加抗返流套叠瓣;C组行单纯胆囊空肠Roux-en-Y吻合术.术后测量3种术式的胆道顺流压和逆流压.临床上采用囊肿切除,肝管十二指肠吻合粘膜乳头成型术治疗13例胆总管囊肿患儿.结果A组的逆流压明显高于B、C组(P＜0.01).临床治疗13例患儿,术后2周有1例出现胆道积气,4年后出现胆道返流症状并发胆管结石,余12例经3.5～7.5年随访,无任何不适的症状.结论肝管十二指肠吻合粘膜乳头成型术具有并发症少及抗返流作用强等优点.     

回盲部间置重建胆道治疗胆总管囊肿的远期疗效观察

目的 为建立一种生理性预防胆肠返流的装置,应用遥回盲部间置重建胆道治疗先天性胆总管囊肿,利用回盲瓣的生理功能防止胆肠返流。方法 切除胆总管囊肿之后,游离回盲部,两部切断形成一个带血管的回盲段,向上翻转间置于肝管十二指肠之间,以重建胆道。结果 临床应用８例病人,术后经钡餐、Ｂ超检查及３￣８年随访,防返流效果良好,无痛及胆道感染表现。结论 回盲部间置重建胆道防返流效果可靠,安全可行无并发症。     

抗返流管置入内引流治疗恶性胆道梗阻

目的：探讨应用抗返流管行姑息性胆肠内引流,对胆道恶性肿瘤术后返流性胆管料的防治效果。方法：将自选研制的抗返流装置应用于26例姑息性胆肠内引流术,观察术后返流性胆管炎的发生情况。结果：20例得到减黄,抗返流效果确实,术后造影结果证实无返流。结论：自行研制的抗返流装置能预防姑息性胆肠内引流术后返流性胆管炎。     

Antiperistaltic Roux-en-Y biliary-enteric bypass after bile duct injury: a technical error in reconstruction.

Bilioenteric reconstruction using a Roux limb of jejunum is a well-established surgical option for the reconstruction of the proximal bile duct. Previous studies discussing short- and long-term complications of biliary-enteric anastomosis have focused on technical aspects, such as the use of anastomotic stenting or the level of the biliary tree used. We report two cases of previously unreported complications after hepaticojejunostomy that resulted from a technical error in constructing the Roux limb. Within a 3-month period, two patients were referred to our institution with recurrent cholangitis after biliary reconstruction for injuries sustained during laparoscopic cholecystectomy. Reexploration disclosed major technical flaws in the construction of the Roux limb used for biliary drainage. Antiperistaltic limbs had been constructed in both patients: one from the distal ileum and one from the conventional location in the jejunum. In both cases, isoperistaltic reconstruction of the Roux limbs resolved the recurrent cholangitis. Cholangitis after biliary-enteric bypass can arise from a variety of etiologies and lead to anastomotic narrowing or ineffective drainage of the biliary tree. Review of the literature failed to disclose reports of technically flawed Roux limb construction as a cause of cholangitis. We present these cases to highlight the devastating consequences of antiperistaltic construction of the Roux limb. We hope that by publishing the role of this avoidable error in recurrent cholangitis after biliary-enteric bypass we may help prevent its future occurrence.     

Effectiveness of an intussusceptive antireflux valve to prevent ascending cholangitis after hepatic portojejunostomy in biliary atresia

An intussusceptive antireflux valve was created in the Roux-en-Y loop at the same time as the hepatic portojejunostomy (Kasai procedure) for the purpose of preventing ascending cholangitis in 14 new cases of biliary atresia and in 6 long-term survivors of the Kasai operation after episodes of ascending cholangitis. Ascending cholangitis did not develop in any of the 13 new patients who showed bile outflow following a modified Kasai procedure with antireflux valve nor in 5 of 6 patients who had secondary valve implementation. Postmortem examination of a patient with a valve who died 2 years 3 months after surgery showed that the structure of the valve was intact and that the valve still was quite effective as an antireflux mechanism.     

胆总管囊肿18例治疗体会

目的　探讨基层医院治疗胆总管囊肿的手术方法及注意事项。方法　对 18例胆总管囊肿患者进行了囊肠内引流及囊肿切除、胆道重建术。结果　囊肠内引流术术后胆道感染、再生结石率高 ,疗效差 ;而囊肿切除胆道重建术者疗效较好。结论　囊肿切除、胆肠Roux Y吻合术配以合适的抗返流装置是值得推荐的手术方法     

Follow up studies on various reconstruction methods of the biliary tract including our new method (Roux Y-duodenojejunal anastomosis)

Thirty six patients with benign diseases of the biliary tract (14 patients with congenital choledochal dilatation, 15 patients with postoperative stricture and 7 patients with others) were divided into three groups: 21 patients who underwent a Roux Y (RY), 7 patients who underwent a jejunal interposition (IP) and 8 patients who underwent a side to side anastomosis between the jejunal limb of the Roux Y and the duodenum (RY-DJ). The RY-DJ was designed to decompress the Roux Y jejunal limb and to allow an inflow of bile into the duodenum. Significant complications, including cholangitis, infection, or abdominal pain, developed in 10 of the patients with RY (48 per cent), 7 of the patients with IP (100 per cent) and 1 of the patients with RY-DJ (13 per cent). None had a postoperative peptic ulcer. Simultaneous scintigraphy showed the time required for the two agents, 99mTc-IDA and 111In-DTPA, to mix at the upper jejunum, which revealed that the time taken by the patients with RY-DJ was similar to that of the patients with IP and to that of healthy controls. The time was markedly longer in the patients with RY, presumably due to a prominent stasis of the bile tracer in the Roux Y jejunal limb. Our new method (RY-DJ) for reconstruction of the extrahepatic biliary tract is more physiological and has less postoperative complications than other conventional methods.     

Follow up studies on various reconstruction methods of the biliary tract including our new method (Roux Y-duodenojejunal anastomosis)

Thirty six patients with benign diseases of the biliary tract (14 patients with congenital choledochal dilatation, 15 patients with postoperative stricture and 7 patients with others) were divided into three groups: 21 patients who underwent a Roux Y (RY), 7 patients who underwent a jejunal interposition (IP) and 8 patients who underwent a side to side anastomosis between the jejunal limb of the Roux Y and the duodenum (RY-DJ). The RY-DJ was designed to decompress the Roux Y jejunal limb and to allow an inflow of bile into the duodenum. Significant complications, including cholangitis, infection, or abdominal pain, developed in 10 of the patients with RY (48 per cent), 7 of the patients with IP (100 per cent) and 1 of the patients with RY-DJ (13 per cent). None had a postoperative peptic ulcer. Simultaneous scintigraphy showed the time required for the two agents,^99mTc-IDA and¹¹¹In-DTPA, to mix at the upper jejunum, which revealed that the time taken by the patients with RY-DJ was similar to that of the patients with IP and to that of healthy controls. The time was markedly longer in the patients with RY, presumably due to a prominent stasis of the bile tracer in the Roux Y jejunal limb. Our new method (RY-DJ) for reconstruction of the extrahepatic biliary tract is more physiological and has less postoperative complications than other conventional methods.     

Duct-to-duct biliary reconstruction in adult-to-adult living donor liver transplantation

In living donor liver transplantation (LDLT), Roux-en-Y hepaticojejunostomy has been a standard technique for biliary reconstruction because the majority had been pediatric patients with biliary atresia. Adult-to-adult LDLT using the right lobe graft has recently been developed and we introduced duct-to-duct biliary reconstruction (hepaticohepaticostomy) in such cases. The aim of this study is to evaluate the feasibility of this procedure in adult-to-adult LDLT. From August 2000 to October 2001, five patients underwent adult-to-adult LDLT using the right hepatic lobe and were followed for more than 6 months at our institution. All patients underwent duct-to-duct biliary reconstruction (single hepaticohepaticostomy in one, multiple in four). For the grafts with multiple bile ducts, various techniques were used for reconstruction. In all patients, oral intake could be started early after the operation, and biliary leakage was not encountered. One patient developed two episodes of acute cholangitis who later developed biliary anastomosis stricture which required percutaneous dilatation at 11 months postop. However, otherwise, there were no infectious complications postoperatively. We conclude duct-to-duct biliary reconstruction is feasible and effective in adult-to-adult LDLT.     

Cystic congenital dilatation of main biliary duct

A case of cystic congenital dilatation of hepatocholedoch, in a patient aged 27, is presented. The malformation affects the entire biliary duct, being classified as Todani Ic type. The diagnosis was intraoperatively established and the surgical solution was the quasitotal extirpation of the hepatocholedoch followed by the reconstruction of the biliary transit through hepaticojejunostomy on Y loop Roux. The postoperative evolution was favourable and the result is still good after 13 years.