空肠肠袢固定在胆肠吻合术治疗肝胆管结石病中的应用

目的:探讨胆肠吻合术治疗肝胆管结石病同时行空肠肠袢固定的治疗效果及意义。方法:回顾性分析2016年1月—2020年1月治疗的16例肝胆管结石病患者,其中9例为胆肠吻合术后吻合口狭窄合并肝内胆管结石,7例为既往未行胆肠吻合,因合并肝门部胆管狭窄初次行胆肠吻合患者。全部病例均行胆肠Roux-en-Y吻合加空肠肠袢固定,原胆肠吻合口狭窄者行重新吻合。全部经固定肠壁处留置T管。结果:胆肠吻合口狭窄患者中行盲袢固定2例,侧壁固定7例;未行胆肠吻合者行盲袢固定6例,侧壁固定1例。共4例发生术后并发症,其中胆瘘2例,切口感染1例,腹腔出血1例,均经保守治疗后治愈,无围手术期死亡。术后随访1例发生吻合口狭窄伴结石,行局麻下空肠穿刺窦道扩张,胆道镜下扩张取石后治愈。结论:肝胆管结石病行胆肠吻合术应慎重,对于结石复发几率较高的病例,术中应尽量固定并标记空肠肠袢,一旦术后胆肠吻合口狭窄或结石复发,可以穿刺固定肠袢行胆道镜治疗,避免再次开腹手术。

Application of jejunal loop fixation in the treatment of hepatolithiasis by cholangiojejunostomy

Objective:To investigate the significance of jejunal loop fixation in the treatment of hepatolithiasis by cholangiojejunostomy.Method:From January 2016 to January 2020,16 patients of cholangiojejunostomy due to hepatolithiasis were analyzed retrospectively,including 9 patients with anastomotic stricture and hepatolithiasis after cholangiojejunostomy,7 patients with portal bile duct stricture or collapse who have not received cholangiojejunostomy before.Roux-en-Y cholangiojejunostomy and jejunal loop fixation were performed in all cases.Original anastomotic opening was removed and re-anastomosed.Results:There were 2 cases of blind loop fixation,7 cases of lateral wall fixation for patients with Stricture of cholangiojejunostomy.There were 6 cases of blind loop fixation,1 cases of lateral wall fixation for patients who have not received cholangiojejunostomy before.Complications occurred in 4 patients,including 2 cases of bile fistula,1 case of incision infection,1 case of abdominal hemorrhage,all of which were cured by conservative treatment,no perioperative death.One case of postoperative stricture of choledochojejunostomy with hepatolithiasis was found in the follow-up.The patient underwent jejunal puncture under local anesthesia,Choledochoscopy after dilatation of sinus,including basket lithotomy and balloon dilatation.Conclusion:Indications should be strictly controlled in the operation of intraintestinal drainage for hepatolithiasis.For cases with high recurrence rate of stones,the jejunal loop should be fixed and labeled during the operation.Once the anastomotic stenosis or recurrence of the stone occurs after the operation,the fixed intestinal loop can be punctured and dilated for choledochoscopy to avoid open surgery once again.