防反流措施对胆肠吻合术后肝胆管结石复发干预的观察

目的 通过术后胆道镜的观察,了解胆肠吻合中的人工乳头瓣膜的防反流效果,探讨胆肠吻合术及人工瓣膜的可行性及其对肝胆管结石复发干预的有效性.方法 51例肝胆管结石病行胆肠Roux-en-Y吻合术的病例.术中均在空肠输出肠袢行人工乳头防反流瓣.术后胆道镜通过T管窦道进入肝胆管,观察肝内外胆道、胆肠吻合口及其反流情况.对于复发的2例通过穿刺建立通道,应用胆道镜进行观察和治疗.结果 术后44例发生胆肠反流(44/51.86.3%); 2例术后复发通过胆道镜诊治,1例结石松软,内以食物渣,纤维素为主.另外1例为松散的食物团.结论 胆肠Roux-en-Y吻合术、空肠输出肠袢行人工乳头防反流瓣并未有效地解决胆肠反流的弊端,复发的结石与反流有关.因此,应该严格和谨慎使用胆肠吻合术.

Means of preventing refluxes influencing hepatolithiasis relapse after choledochojejunostomy

Objective To investigate the effect of artificial valve of efferent loop in preventing reflux by the choledochoscopy technique and evaluate its feasibility and efficacy of means of preventing refluxes influencing hepatolithiasis relapse after choledochojejunostomy.Methods A total of 51 cases with hepatolithiasis had been operated on with Roux-Y cholangioiejunostomy and artificial valve of ef-ferent loop to prevent biliointestinal regurgitation.The regurgitation,recurrence,biliary duct and the anastomotic ora were investigated through the T tube sinus by the choledochoscopy after operation.Through sinus built by the percutaneous puncture,we had treated and observed 2 eases with hepatoli-thiasis relapse by the choledochoscopy.Results Of the 44 cases having the biliointestinal regurgitation (44/51.86.3%),2 with hepatolithiasis relapse post-choledochojejunostomy were diagnosed and trea-ted with choledochoscopy.The stones in 1 case were soft and there were many food residue and cellu-lose.Conclusion Roux-en-Y choledochojej unostomy and subjoining the artificial valve of efferent loop is not effective in preventing reflux.Relapsing of the calculus has something to do with biliointestinal regurgitation.Therefore,the choledochojejunostomy should be taken cautiously and strictly.