胆道疾病胆肠吻合术后并发症

胆肠吻合术是目前临床上治疗胆道疾病最常用的术式之一，适用于胆道狭窄或梗阻的重建。术式包括胆总管（或囊肿）与十二指肠吻合术及胆管空肠吻合术。由于前者术后发生感染概率高，容易发生囊肿感染和癌变，在1997年西安全国胆道外科会议上，黄志强教授曾指出应该废除该术式。胆管空肠Roux-en-Y吻合术最早由CesarRoux于1893年首次报告，目前已非常普及，临床择期手术时基本上采用后者。但术后出现反复发作性胆管炎、     

对胆肠吻合术的再认识

胆肠吻合术是治疗胆道外科疾病、重建胆汁引流的重要方法,是胆道外科最常应用的手术方法之一.在多年的临床实践中,胆肠吻合的术式不断改进,在不同的历史时期均有其代表性术式.     

胆肠吻合术后返流性胆管炎的防治

目的 探讨胆肠吻合术后反流性胆管炎的预防和合理治疗。方法 分析14例反流性胆管炎的临床表现，影像学特征以及外科治疗的效果。方法 寒战，高热和右上腹疼痛是反流性胆管炎的典型临床表现，部分患者可见钡剂反流，采用离断幽门加胃肠吻合，拆除原吻合口，以及适当延长胆肠Roux-en-Y吻合肠袢的长度等方法治疗后，所有病例的临床症状消失，反流治愈。结论 慎用胆总管十二指肠吻合术和保留适当长度肠袢的Roux-en-Y吻合术是预防反流性胆管炎的有效措施。     

腹腔镜胆肠吻合术

目的 介绍腹腔镜胆肠吻合术（LCJS）这一新术式。方法 回顾分析国内外相关文献，对LCJS详尽加以综述。结果 LCJS可完全在腹腔镜下完成，亦可在腹腔镜辅助下完成。方式有胆囊空肠吻合、胆总管空肠吻合。结论 LCJS在技术上是可行的，但要注意手术的适应证、禁忌证，并预防术后并发症的发生。     

返流性胆管炎与胆肠吻合术

目的 探讨返流性胆管炎的病因、治疗与胆肠吻合术的关系。方法 回顾性研究74例返流性胆管炎的病因、病理、治疗方法和效果。结果 胆道返流的主要原因为胆总管十二指肠吻合(19例)或Oddi括约肌切开(2例)术后和Oddi括约肌松弛，失去抗返流功能(53例)。反复胆道返流可导致肝胆系统急慢性炎症、结石再发。行胆管空肠Roux—en—Y型吻合术38例和胃部分切除胃空肠吻合术20例，观察6年半的优良率为83％。结论 反复胆道返流与胆管炎和结石再发密切相关，通过外科手术消除或减轻胆道返流因素，可获得良好的效果。     

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、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阻。15例伴有结石取净结石。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。     

胆肠吻合术后发生吻合口空肠腺癌1例报道

患者男性，59负。因间歇性右上腹痛15年，于1985年11月12日入院。术中见胆总管内经2cm，内有数枚结石。取石后行胆肠Roux-y例端吻合术。术后2年7个月因右上腹痛伴发热、全身皮肤黄染再次入院。行PTC示肝内胆管明显扩张，吻合口通而不畅，靠肝门区见一线状环形狭窄。     

谈谈胆肠吻合术

胆肠吻合术在我国实施还很普遍。适应证和作法各家意见也很不一致。我个人认为现在行之过多，应当慎重对待。现谈３个问题供讨论：①适应证；②肝内结石或／和狭窄的合理处理；③胆肠吻合术式和方法。１胆肠吻合术的适应证胆肠吻合是一个永久性的内引流术，不同于外引流，...     

降落伞式吻合在胆肠吻合术中的应用

目的改进胆肠吻合缝合技术,减少胆漏的发生。方法对124例胆肠吻合手术采用Prolene线进行降落伞式吻合。结果降落伞式胆肠吻合时间平均11min,明显缩短了手术时间,全部病例均未出现胆肠吻合口漏,无手术死亡。结论降落伞式胆肠吻合术具有操作简便、省时、并发症少等特点。     

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。     

改良胆肠袢式吻合术的疗效分析

目的 探讨改良胆肠袢式吻合术的远期效果.方法 回顾性分析2000年1月至2006年12月中山大学附属第一医院收治的259例行胆肠吻合术患者的临床资料.其中行改良胆肠袢式吻合术130例(改良组),行Roux-en-Y吻合术129例(对照组).比较两组术后胆管炎发生率、肝功能的变化.采用t检验、χ2检验或Fisher确切概率法对结果进行分析.结果 术后改良组ALT、ALP分别为(63±42)U/L、(147±147)U/L,对照组分别为(84±52)U/L、(256±201)U/L,两组比较差异无统计学意义(t=1.634,1.655,P>0.05);改良组GGT为(116±91)U/L,低于对照组的(169±96)U/L(t=2.461,P<0.05).两组共有12例患者出现不同程度的急性胆管炎,其中改良组有3例(2.3%),对照组有9例(7.0%),改良组少于对照组,但差异无统计学意义(P>0.05).发生急性胆管炎的患者中,改良组有1例需住院治疗,对照组有7例,两组比较差异有统计学意义(P<0.05).结论 改良胆肠袢式吻合术与Roux-en-Y吻合术后急性胆管炎的发生率比较差异无统计学意义,但其术后急性胆管炎的发作频率更低、症状更轻,且操作简单,可作为常规胆肠吻合的方法.     

胃毕Ⅱ式术后利用十二指肠残端行胆肠吻合术

毕Ⅱ式胃大部切除术后胆石症的发病率逐渐增 高,1999-2001年我们利用十二指肠残端行胆总管 十二指肠侧侧吻合术治疗毕Ⅱ式胃大部切除术后胆 石症并胆总管狭窄病人11例,取得了良好疗效。 临床资料 1.一般资料:本组均为男性,年龄57～78岁,平 均66.8岁。全部病人均因胃十二指肠溃疡、出血、 或穿孔行胃大部切除,胃大部切除距胆总管十二指 肠吻合术18～30年不等。2次手术史者3例:例1 于术前10年因胆囊结石、慢性胆囊炎行胆囊切除, 10年后出现胆总管结石并狭窄、左肝胆管大量结 石;例2于术前2年半因胆囊坏疽,胆总管结石并 AOSC…     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.     

胆肠吻合术后胆道再手术的处理

我院近１０年行胆肠吻合术后胆道财手术２６例，其中采用肝胆管空肠Ｒｏｕｘ－Ｙ吻合术１６例，间置空肠胆肠合术４例，吻合口刀开成形术６例，全组手术经过顺利，术后死亡２例，其余患者顺利出院，随访期间病故１例，有急性胆管炎发作１例，其余患者恢复正常生活。     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.