胆肠吻合口狭窄再次手术的处理

目的 探讨胆肠吻合口狭窄再次手术的处理方式及预防要点。方法 回顾性分析2014年1月至2022年3月无锡市第二人民医院实施再次手术治疗的13例胆肠吻合口狭窄患者的病例资料。13例中12例有胆管结石伴胆管炎发作病史，另1例为腹腔镜下胰十二指肠切除术后早期梗阻性黄疸。其中8例行开腹胆肠吻合口重建，2例行ERCP下胆肠吻合口扩张术，2例行腹腔镜下胆肠吻合口重建，1例行PTCD下胆道扩张治疗。结果 本组患者经过治疗后黄疸、腹痛、胆道感染等症状均得到缓解，术后恢复良好并顺利出院。13例患者术后随访至2022年10月，其中12例患者术后无胆管炎及肝内胆管结石复发，1例合并胆管腺癌患者术后6个月因肿瘤进展死亡。结论 胆管结石复发是胆肠吻合口狭窄的最常见原因。胆肠吻合口拆除重建、经皮经肝胆管介入治疗和经内镜行ERCP治疗都是治疗胆肠吻合口狭窄的重要手术方式。初次手术实施规范化胆肠吻合术的是预防狭窄的重点。一旦出现胆肠吻合口狭窄，需要制定个体化的治疗方案。

Treatment of reoperation for stenosis after biliary-enteric anastomosis

Objective To explore the key prevent point and proper surgical treatment for stenosis after biliary-enteric anastomosis. Methods The clinical data of 13 patients who underwent surgical treatment for stenosis after biliary-enteric anastomosis in Wuxi Second People’s Hospital from Jan. 2014 to Mar. 2022 were retrospectively analyzed. Twelve of the 13 patients had bile duct stones with cholangitis and the other one had early obstructive jaundice after laparoscopic pancreaticoduodenectomy. Among them, 8 cases underwent open biliary-intestinal reconstruction, 2 cases were treated with biliary balloon dialatation under ERCP, 2 cases underwent laparoscopic biliary-intestinal reconstruction, and 1 case was treated with biliary tract expansion under PTCD. Results The symptoms including jaundice, abdominal pain and biliary infection were alleviated after surgery. Until follow-up to Oct. 2022, 12 patients recovered well after operation, and 1 patient with bile duct adenocarcinoma died 6 months after the operation because of tumor progression. Conclusion Recurrence of bile duct stones is the most common reason for stenosis after biliary-enteric anastomosis. Biliary-intestinal anastomosis reconstruction, PTCD biliary tract expansion and endoscopic ERCP are important surgical treatments for stenosis after biliary-enteric anastomosis. The primary implementation of standardized biliary-intestinal anastomosis is the key prevent point of stenosis after biliary-enteric anastomosis, and once occurred, an individualized treatment plan should be designed after comprehensive and multidisciplinary discussion.