胆管空肠Roux—en—Y吻合术后再手术原因及对策

目的 探讨胆管空肠Roux-en-Y吻合术（胆肠R－Y吻合术）后再手术的原因及对策。方法 对我院1988年1月至1999年10月收治的20例胆肠R－Y吻合术后再手术病人的临床资料作回顾性分析。结果 再手术原因有：肝内胆管狭窄伴结石4例；肝门胆管狭窄伴结石6例；吻合口狭窄伴结石4例；单纯吻合口狭窄3例；反流性胆管炎2例；胆管末端漏斗综合征1例。再手术方式：吻合口切开整形并左肝外叶切除2例；肝门胆管切开整形，取尽结石后行高位胆管空肠再吻合7例；原吻合口扩大整形，取石8例；吻合口切开整形，桥袢延长并人工空肠套叠1例；经空肠盲袢取石，吻合口扩大成形1例；吻合口切除，胆肠端侧吻合，胆总管盲端 关闭1例。全组病人经治疗后均痊愈出院。结论 胆肠R－Y吻合术及以后的再手术均应以取尽结石，纠正狭窄，去除病灶，通畅引流为原则，方可提高疗效，减少再手术率。

Causes and Measures of Reoperation after Roux-en-Y Choledochojejunostomy

Objective To discuss the causes and measures of reoperation after Roux en Y choledochojejunostomy. Methods 20 patients underwent reoperations after Roux en Y choledochojejunostomy from 1988.1 to 1999.10 were analyzed.Results The causes of reoperation were as follows: intrahepatic biliary stricture with stones in 4 cases, porta hepatis bile duct stricture with stones in 6 cases, anastomotic stoma stricture with stones in 4 cases, simple anastomotic stoma stricture in 3 cases, reflux cholangitis in 2 cases, funnel syndrome in 1 case. The measures of reoperation were as follows: opening of the anastomotic stoma and resection of the left lateral lobe of the liver in 2 cases; choledochojejunostomy after opening of the hilar bile duct with orthoplasty and extraction of the stones in 7 cases, expanding of the primary anastomotic stoma and extraction of the stones in 8 cases, opening of the anastomotic stoma and lengthening of the ascending jejunal pontoon with a factitious intersuscception on it in 1 case, extraction of the stones and expanding of the anastomotic stoma through the blind jejunal loop in 1 case, dissection of the original anastomotic stoma and made a new end side choledochojejunostomy with closing of the lower blind end of the common duct in 1 case. All the patients were discharged in good condition. Conclusion It is suggested that complete extration of the stones, correction of the stricuture, removal of the unsound tissue and establishment of a free drainage are the key points to the enhancement of the surgical effects and the reduction of the reoperation rate in Roux en Y choledochojejunostomy or the second time operation.