Roux-en-Y hilar-jejunum anastomosis for biliary tract reconstruction after radical resection of hilar cholangiocarcinoma

中华普通外科杂志 Pub Date : 2020-02-25 DOI:10.3760/CMA.J.ISSN.1007-631X.2020.02.001

Zhedong Zhang, Dafang Zhang, Weihua Zhu, Jiye Zhu, Shu Li, X. Leng

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Abstract

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma. Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed. Results According to Bismuth-Corlette classification there were 6 cases of IIIa, 6 cases of IIIb and 19 cases of type IV. These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis, with intraoperative blood loss of 50-4000 ml (on average of 1146±1082 ml). The average operation time was (346±118) min, and the average hilar-jejunum anastomosis time was (35±13) min. The average postoperative hospital stay was (20±11) days. There were 25 cases of R0 resection(80.6%). The postoperative complication rate was 25.8% (8/31). The overall median survival time was 21 months, and the 1-, 3-, and 5-year survival rates were 68.8%, 14.6%, and 3.6%, respectively. During the follow-up period, 7 cases of reflux cholangitis, 5 cases of biliary anastomotic stenosis, and 1 case of adhesive intestinal obstruction were found. Conclusion The hilar-jejunum anastomosis is simple, safe, widely applicable prcedure, which is easy to perform. Key words: Bile duct neoplasms; Roux-en-Y hilar-jejunum anastomosis; Postoperative complications

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Roux-en-Y肝门-空肠吻合术在肝门胆管癌根治术后胆道重建中的应用

目的探讨Roux-en-Y肝门空肠吻合术在肝门部胆管癌手术切除中的作用。方法回顾性分析2009年2月至2017年2月收治的31例肝门部胆管癌切除后行Roux-en-Y肝门空肠吻合术的临床资料。结果按Bismuth-Corlette分型，IIIa型6例，IIIb型6例和IV型19例。这些患者都成功地进行了Roux-en-Y肝门空肠吻合术，术中失血量为50-4000ml（平均1146±1082ml）。平均手术时间为（346±118）min，平均肝门-空肠吻合时间为（35±13）min，术后平均住院时间为（20±11）天。R0切除25例（80.6%），术后并发症发生率25.8%（8/31）。总的中位生存时间为21个月，1、3和5年生存率分别为68.8%、14.6%和3.6%。在随访期间，发现7例反流性胆管炎，5例胆道吻合口狭窄，1例粘连性肠梗阻。结论肝门空肠吻合方法简单、安全、适用范围广、操作简便。关键词：胆管肿瘤；肝门空肠Roux-en-Y吻合术；术后并发症

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中华普通外科杂志

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