胆肠吻合术后吻合口狭窄的非手术治疗

目的 探讨胆肠吻合口狭窄非手术治疗的方法和疗效。方法8例经皮下盲袢、13例经T管窦道进入胆道镜,先气囊扩张狭窄,再取狭窄上方结石,瘢痕性狭窄置硬塑管支撑3-6个月;恶性狭窄胆道镜引导置金属支架。12例行PTCD;恶性狭窄不伴结石,放射介入置金属支架;如有结石或瘢痕狭窄,先扩张窦道、后经PTCS取石或置金属支架。硬塑管。全组气囊扩张19例、置硬塑管5例、置金属支架9例。结果33例中24例良性狭窄,扩张19例、置硬塑管5例均解除梗阻,9例恶性狭窄8例置金属支架解除梗附。15例伴有结石者取净结石。全组无严重并发症。结论 借助胆道镜的非手术方法在治疗胆肠吻合术后吻合口狭窄中创伤小、副损伤少、疗效确切。

Non-operative therapy of anastomotic stenosis after cholangiojejunostomy

Objective To investigate the methods and therapeutical effect of nonoperative therapy for anastomot-ic stenosis after cholangio - jejunostomy. Methods Passed the choledochofiberoscope through subcutaneous blindloop (8 cases) and T tube sinus (13 cases). The stenosis was dilated by ballon catheter, then stones above the stenosis were taken out. Rigid plastic tube were implanted in cicatrical stenosis site for 3 - 6months. Metal stents could be used in malignant stenosis by choledochofiberoscope. PTCD were performed in 12 cases. Metal stents were placed in malignant stenosis without bile duct stones by choledochofiberoscope and X - rays. If stones or cicatrical stenosis existed, firstly the sinus was dilated, then stones were removed out using percutaneous transhepatic choledochoscopy (PTCS), metal stand was implanted for malignant stenosis or rigid plastic tube for ciatrical stenosis by choledochofiberoscopy and X-ray. Results There were 24 benign stenosis in all 33 cases. Dilation was performed in 19 cases rigid plastic tube were implanted in 5 cases. Stenosis was successfully relieved in all cases. Restenosis developed in 2 cases after 8-36 months. Of 9 cases with malignant stenosis, obstruction were relieved in 8 cases by metal stent implantation. 3 cases died for he-mobilia or metastasis after 4-18 month. Choledochofiberoscope was successfully used in 15 cases with bile duct stones. Conclusions Nonoperalive therapy by choledochofiberoscope and X - ray is less traumatic and highly effective in the treatment of anastomotic stenosis alter cholangiojejunostomy.