胆管空肠Roux-Y吻合加T管支撑引流治疗肝内胆管结石15例报告

肝内胆管结石是一种较常见疾病。以往各种手术方式均难以达到理想的治疗目的。自１９４５年Ａｌｅｎ［１］应用胆管空肠Ｒｏｕｘ－Ｙ吻合术以来，经过不断的研究和改进，日趋完善和合理，已广泛应用在各类肝胆管结石手术的胆道重建。然而仍有一部分病人疗效不佳。我院自１...     

胆肠Roux-Y吻合附加空肠粘膜瓣成形术(附11例报告)

胆肠Roux-Y吻合术已陂胆道外科广泛应用。为了防止该种手术后的胆道返流,许多学者曾致力于该种手术的改进,但是尚未获得圆满解决。我们设计了一种胆肠Roux-Y吻合附加空肠粘膜辦成形术。临床应用11例,已经获得满意疗效。本文重点介绍该手术的方法、手术适应证及其评价等。     

胆管空肠Roux-Y吻合术后再吻合手术

肝胆管结石患者行胆管空肠Roux-Y吻合是治疗肝内胆管结石常见的手术之一,本文仅就我院1992～1999年收治的48例肝内胆管结石患者施行胆管空肠Roux-Y手术后再手术的几个问题作如下分析讨论.     

Roux-Y桥襻空肠结石14例报告

目的 探讨Roux-Y术后桥襻空肠结石的诊断、治疗及预防措施.方法 收集Roux-Y术后14例桥襻空肠结石患者的临床资料.结果 14例患者均经手术痊愈出院,无任何并发症.结论 桥襻空肠结石术前通过B超、CT明确诊断,可通过外科手术取出结石,重建胆肠吻合.     

胆管空肠Roux-en-Y吻合治疗肝胆管结石及胆道狭窄103例体会

目的探讨肝门部胆管空肠吻合治疗肝胆管结石及胆道狭窄的疗效。方法对我院1991年9月~2004年9月采用肝胆管空肠Roux-en-Y吻合治疗肝胆管结石及胆道狭窄103例的临床资料进行回顾性分析。本组均以肝胆管切开取石、整形、高位胆肠吻合术进行治疗。结果本组无手术死亡病例。术后发生并发症11例,发生率为10.7%,均经非手术治疗治愈。手术后随访87例,随访时间1~8年。结石复发率为8%,优良率为90.8%。结论肝门部胆管空肠Roux-en-Y吻合对肝胆管结石及胆道狭窄有良好的治疗效果。     

纤维胆道镜治疗术后胆管残留结石(附62例报告)

使用纤维胆道镜治疗了62例术后胆管残留结石的病人。57例病人结石取净,取净率91.94％。肝胆管结石病人术后残石率高是目前胆道外科难题之一,术后通过胆道镜从T管窦道取石是一个切实有效的途径。T管的放置直接影响术后胆道镜取石的顺利进行。为方便术后取石应选择较粗的T管,T管的放置以“短、直、宽”为原则。术后要注意T管的保护,T管造影、B超、CT等的检查使胆道镜取石前有一个初步的定位诊断,减少漏诊。胆道镜操作技巧的熟练和取石器械的进步是提高结石取净率的有效保证。随着纤维胆道镜技术的发展必能促进肝胆管结石的治疗不断完善。     

腹腔镜联合胆道镜治疗肝内外胆管结石(附82例报告)

肝内外胆管结石是临床上常见多发疾病。我院2000年2月开始行腹腔镜胆道探查术治疗胆总管结石70例,2003年11月开始完全腹腔镜下左肝外叶切除治疗肝内胆管结石12例,报告如下。临床资料一、一般资料本组82例,男34例,女48例,年龄22~63岁,平均46岁。术前诊断胆总管结石70例,左肝内胆     

胆管空肠吻合治疗复发性胆总管结石25例分析

目的 观察胆管空肠吻合对复发性胆总管结石的治疗价值.方法 以2000 年1 月~2010 年12 月间我科进行的25 例胆总管空肠Roux-Y 吻合治疗的复发性胆总管结石患者为对象,对其治疗效果进行回顾性研究.结果 25 例复发性胆总管结石均得到治愈,无胆瘘发生,20 例随访1~4 年均无胆系感染症状.结论 复发性胆总管结石有以下情况者行胆管空肠吻合术效果满意:譹訛曾经行胆总管切开引流术而又有结石再生,胆总管的管壁已明显肥厚、口径>2.0~2.5 cm 以上者;譺訛胆总管尤其是肝管内同时塞满泥沙样结石不易彻底清除者;譻訛有块状结石嵌顿在壶腹部无法去除者;譼訛壶腹部或乳头括约肌有严重痉挛或疤痕狭窄,术中不能用探针通过十二指肠,或测得胆道压力高于15~30 mmH2O 者.     

应用纤维胆道镜治疗肝内外胆管结石(附88例分析)

应用纤维胆道镜治疗肝内外胆管结石88例。在胆道手术中应用纤胆镜检查取石20例,术中取净17例,胆道术后残石率由未行术中纤胆镜的62％降至15％。在术后应用纤胆镜检查取石68例中,检查10例,取胆总管结石7例均取净,取肝内胆管结石51例取净48例。结石取净率为94％。本研究采用术中纤胆镜取石的改进方法,缩短了取石时间,提高了取石的效果和手术的质量。本研究报告了结石在肝内Ⅰ～Ⅳ级肝管的分布和治疗效果,探讨了取肝内结石的体会。     

胆管空肠Roux-Y吻合术后胆道感染发生的原因

目的探讨胆管空肠Roux-Y吻合术后胆道感染的发生率及其原因。方法回顾研究1997年7月~2004年10月行胆管空肠Roux-Y吻合术62例,以及12例既往行胆管空肠Roux-Y吻合术,因胆道感染入我院再次手术的病例资料。结果62例中7例(占11.3%)出现术后胆道感染,平均随访44.1月,4例再手术,均发现胆管空肠Roux-Y吻合口狭窄。有吻合口直径资料56例,吻合口直径≤2.0 cm的20例中5例(占25.0%)出现术后胆道感染;直径>2.0 cm,36例中仅1例(占2.8%)出现胆道感染。在12例胆管空肠吻合术后胆道感染再次手术病例中,发现原吻合口狭窄8例(占66.7%),吻合口以上胆管狭窄3例,1例空肠失功肠襻胆石性肠梗阻。结论胆管空肠Roux-Y吻合术后胆道感染的发生率较低;胆道引流不畅是胆管空肠Roux-Y吻合术后发生胆道感染的主要原因,吻合口狭窄是术后胆道引流不畅的重要因素。     

Y Roux anastomosis of small intestine in gastrectomy and esophagectomy

A clutch-like method of esophagojejunal anastomosis on the excluded by the Roux method loop of the small intestine was worked out in experiments on 80 corpses of humans. It was found that the anastomosis should be made at a distance of 3.2 +/- 0.48 cm (two diameters of the patient's esophagus) from the tightly sutured part of the small intestine. In the clinic there were no cases of incompetence of the anastomosis sutures in 86 gastric cancer patients aged from 31 to 71 years (81 gastrectomies and 5 extirpations of the gastric stump). Two patients died (2.3%). The follow-up of the patients during 1-10 years after operation has found that mild reflux-esophagitis developed in 6.1% of the patients, average degree--in 2.04%. No cicatricial strictures of the anastomosis were revealed. The method was used in 6 patients in gastroplasty after Kupriyanov-Zakharov. The dumping syndrome of mild degree developed in 23.6%, average--in 2.7% of the patients. The anastomosis can be used in gastrectomy as a method of choice in extirpation of the gastric stump.     

Long limb Roux en Y gastric bypass revisited

Roux-en-Y gastric bypass (RYGB) that is performed with at least a 150-cm Roux limb results in significantly greater weight loss than shorter (<100-cm) Roux limb procedures in superobese patients(BMI >50 kg/m2). Conversely, longer Roux limb procedures do not provide greater weight loss in less obese (BMI <50 kg/m2)patients. Modest elongation of the Roux limb-in the range of 150 cm to 200 cm-does not result in more frequent nutritional sequelae compared with shorter Roux limb procedures. This article discusses the current status of long limb Roux-en-Y gastric bypass in the context of weight loss, metabolic sequelae and CPT coding.     

Roux en Y Gastric Bypass Increases Ethanol Intake in the Rat

Roux en Y gastric bypass (RYGB) surgery is currently the most effective therapy employed to treat obesity and its associated complications. In addition to weight loss and resolution of metabolic syndromes, such as diabetes, the RYGB procedure has been reported to increase alcohol consumption in humans. Using an outbred rodent model, we demonstrate that RYGB increases postsurgical ethanol consumption, that this effect cannot be explained solely by postsurgical weight loss and that it is independent of presurgical body weight or dietary composition. Altered ethanol metabolism and postsurgical shifts in release of ghrelin were also unable to account for changes in alcohol intake. Further investigation of the potential physiological factors underlying this behavioral effect identified altered patterns of gene expression in brain regions associated with reward following RYGB surgery. These findings have important clinical implications as they demonstrate that RYGB surgery leads directly to increased alcohol intake in otherwise alcohol nonpreferring rat and induces neurobiological changes in brain circuits that mediate a variety of appetitive behaviors.     

腹腔镜联合纤维胆道镜治疗肝外胆管结石

【摘要】目的 总结腹腔镜联合胆道镜治疗胆道结石的临床应用体会。方法 回顾分析27例胆道结石患者联合应用腹腔镜纤维胆道镜微创治疗的临床资料。 结果 27例患者平均手术时间为85min,术后平均住院7.4d;胆总管Ⅰ期缝合12例患者均顺利完成手术,无中转开腹病例。结论 腹腔镜联合胆道镜治疗胆道结石具有创伤小、出血少、感染率低、术后恢复快等优点,治疗胆道结石安全有效。