高位胆管空肠Roux-en-Y吻合术后吻合口狭窄再手术15例诊疗体会

目的探讨高位胆管空肠Roux—en-Y吻合术后吻合口狭窄行吻合口重建的手术方法。方法回顾性分析2007年2月至2011年11月间的15例因高位胆管空肠Roux-en-Y吻合术后吻合口狭窄再手术的患者临床资料。结果 15例全部行吻合口重建,术中切除原胆肠吻合口行规范的肝门胆管空肠吻合7例,行肝总管空肠吻合6例,1例切除肝方叶后行左右肝管空肠吻合,左肝外叶切除3例;15例随访时间平均33.2月,术后胆漏1例,3例有胆管炎表现。结论打开肝门板显露胆管汇合处是高位胆管-空肠吻合得以重建的关键;再手术时需采用个体化的手术方案。

Reoperation after Roux-en-Y cholangioenterostomy with hilamrieture of anastomotic stoma:a report of 15 cases

Objective To study the management of anastomotic stoma reconstruction after Roux-en-Y cholangioenterostomy with hilamrieture of anastomotic stoma.Methods A retrospective analysis was made on the clinical data of 15 patients who underwent reoperation after Roux-en-Y cholangioenterostomy with hilamrieture of anastomotic stoma from February 2007 to November 2010.Results All the 15 patients were accepted reoperation.After dismantling the primary anastomosis,7 were subjected to portal hepatic cholangio-jejunostomy,6 were subjected to common hepatic duct cholangio-jejunostomy,1 to right and left hepatic duct cholangio-jejunostomy after side lobe resection and 3 to hepatic left lateral lobectomy.The follow-up of 15 patients averaged 3 3.2 months,showed that 1 patient had bile leakage and 3 patients still had cholangitis,.Conclusion The skills for revealing the primary anastomotic are the key to high position cholangioenterostomy.Individualized surgical program is needed in the reoperation.