【摘要】 目的　探讨胆肠吻合术后再手术的原因及处理方法。方法　回顾性分析 1995年6月～ 1999年 6月间 2 8例胆肠吻合术后再手术的临床资料。结果　 2 8例中 ,吻合口狭窄2 6例 (92 8% ) ,伴左肝管狭窄 9例 ,右肝管狭窄 3例 ,左右肝管狭窄 5例。钡餐造影 9例见胆管内返流 ,均为胆总管十二指肠吻合者。再手术方法 :原吻合口切除再吻合 3例 ,左肝外叶切除、肝门胆管整形与空肠Roux en Y吻合 8例 ,左肝管、肝门胆管与空肠双口吻合 2例 ,肝内胆管狭窄切开并整形后与空肠Roux en Y吻合 15例。 2 6例 (92 8% )随访 0 5 - 4年 ,仅 1例 (3 8% )间有轻度感染症状。结论　胆肠吻合口狭窄是再手术的根本原因 ,其次是术式选择不当、肝胆管狭窄未予解除及结石清除不彻底。再手术时应遵循清除结石、解除狭窄及通畅引流的原则 ,必要时结合肝段 (叶 )切除、吻合口支撑引流及术中、术后胆道镜处理。更多还原

【Abstract】 Objective To study the causes and management of the reoperation after cholangiointestiostomy(CIS). Methods A retrospective analysis was made on the clinical data of 28 cases of reoperation after CIS from June 1995 to June 1999. Results Among the 28 cases, 26 cases(92%) had CIS anastomotic stenosis. Of the 26 cases, 9 cases accompanied with left hepatobiliary duct stenosis, 3 cases with right hepatobiliary duct stenosis, 5 cases with left and right hepatobiliary ducts stenosis. 9 cases with biliary reflux comfirmed by barium meal radiography, all of the 9 cases were subjected to a choleduodenostomy. Of the 28 patients, 3 underwent reanastomose after excision the primary anstomosis, 8 operated with hilar bile duct reform and left lateral hepatolobectomy, 2 with left hepatic duct jejunostomy and hilar bile duct jejunostomy. 15 cases with intrahepatic bile duct jejunal Roux en Y anastomosis, after resolved the intrahepatic bile duct stenosis. Conclusions The basic cause of reoperation after CIS is anastomotic stenosis, the other causes are as follows: the selected operation is unsuitable, the intrahepatic bile duct stenosis is not resolved, and the stonedoes not clean out completly. When reoperation is performed on these cases, the following principles must be abided by: romoving all the stones, resolving the stenosis, making a clear drainage; and performing hepatic lobectomy, anastomotic sustaining and drainage, and cholefibroscopic management must be done if needed.更多还原