肝肠吻合术在胆肠吻合口狭窄治疗中的应用

B. Bhat, S. Ray, S. Lalwani, V. Mangla, N. Mehta, A. Yadav, S. Nundy
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引用次数: 0

摘要

背景:Roux-en-Y肝空肠吻合术(RYHJ)是胆囊和胆管手术后狭窄的常用引流方法。然而,8%-40%的吻合口再次变窄,重做手术在技术上具有挑战性。只有几份报告审查了这些修订程序的结果,因此我们决定分析我们在这一不同寻常的行动中的经验。目的:探讨肝-空肠吻合术在胆肠吻合口狭窄治疗中的作用。材料和方法:2010年1月至2016年1月,我们在我科为良性适应症进行了首次肝空肠吻合术后的狭窄进行了23例肝空肠吻合术,并随访了至少2年的临床、生化和影像学检查。结果:男性7例,女性16例,中位年龄37岁(15 ~ 63岁)。手术至狭窄复发的中位时间间隔为10个月。13例(57%)患者接受了首次手术翻修,10例在经皮介入治疗失败后接受了手术。中位住院时间为10天,21例(91%)仅有轻微并发症。无手术死亡率。在所有23例患者2-8年后的随访中,6例(26%)患者出现狭窄复发,其中3例经皮扩张治疗,3例需要第二次翻修手术。17名患者无症状。结论:重做RYHJ是初始胆道肠吻合术后狭窄的可行选择,无手术死亡率,四分之三的患者无症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Redo hepaticojejunostomy in the management of bilioenteric anastomotic strictures
Background: The Roux-en-Y hepaticojejunostomy (RYHJ) is the commonly done drainage procedure for strictures which occasionally follow operations on the gallbladder and bile ducts. However, 8%–40% of these anastomoses become narrowed again and the redo operation is technically challenging. There are only a few reports which have examined the results of these revision procedures and we therefore decided to analyse our experience of this unusual operation. Aim: To study the role of redo-hepaticojejunostomy in the management of bilio-enteric anastomotic strictures. Materials and Methods: Between January 2010 and January 2016, we performed 23 redo-hepaticojejunostomies for the strictures following an initial hepaticojejunostomy which was done for benign indications in our department and followed them for a minimum of 2 years with clinical, biochemical and radiological tests. Results: There were 7 males and 16 were females who had a median age of 37 years (range 15–63 years). The median interval between the index operation and the stricture recurrence was 10 months. Thirteen (57%) patients underwent initial surgical revision and 10 had the procedure following unsuccessful percutaneous intervention. The median length of hospital stay was 10 days and 21 (91%) only had minor complications. There was no operative mortality. On follow-up of all 23 patients after 2–8 years, six (26%) patients developed stricture recurrence, of whom three were managed with percutaneous dilatation and three required a second revisional surgery. Seventeen patients are symptom-free. Conclusion: Redo RYHJ is a feasible option for strictures following an initial biliary enteric anastomosis with no surgical mortality and three-quarters of the patients being rendered symptom-free.
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