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李 宇1,张军强2,王 铮1,仵 正1,吕 毅1,刘学民1
Abstract: Laparoscopic redo hepaticojejunostomy for benign bilioenteric anastomotic stricture:a preliminary study LI Yu, ZHANG Jun-qiang, WANG Zheng,et al.*Department of Hepatobiliary Surgery, the First Hospital of Xi’an Jiaotong University, Xi’an 710061, China Corresponding author:LIU Xue-min, E-mail:a1090224@163.com Abstract Objective To analysis the feasibility and efficiency of laparoscopic redo bilioenteric anastomosis for benign bilioenteric anastomotic stricture (BBEAS). Methods Retrospective case control study was used. From the January 2017 to the June 2019, 11 patients with BBEAS underwent laparoscopic redo hepaticojejunsotmy in the First Hospital of Xi’an Jiaotong University (laparoscopic group); While 13 patients, who received percutaneous transhepatic cholangiodrainage (PTCD) and balloon dilation at the same period, were enrolled in the controlled group (PTCD group). The data, including demographic factors, procedure-related results and follow-up, were compared. Results The data were comparable in two groups, excepting the onset time of BBEAS in laparoscopic group was significantly later. The clinical successful rate (10/11 vs.12/13, χ2=0.15,P=0.9) and incidence of complications (1/10 vs. 11/57,χ2=0.5, P=0.48) were similar in two groups, but the laparoscopic group needed much less treatment duration (14 d vs. 161d, Z=-3.5,P=0) and procedure times per patients (1 vs. 4.4, T=-6.4,P=0). After an average follow-up of 26.0±10.8 months, the stricture recurrence ratio was similar in two groups (1/10 vs. 4/12,χ2=1.7,P=0.19). Conclusion Laparoscopic redo hepaticojejunostomy issafe and effective for BBEAS.
Key words: laparoscopy, benign bilioenteric anastomotic stricture, re-operation, percutaneous transhepatic cholangiodrainage, stricture recurrence
摘要: 目的 探讨腹腔镜下再次胆肠吻合在治疗良性胆肠吻合口狭窄(BBEAS)中的可行性和有效性。方法 采用回顾性病例对照研究。2017年1月至2019年6月,11例行开放手术后BBEAS病人再行腹腔镜下再次胆肠吻合术治疗(腹腔镜组),同期有13例BBEAS病人接受经皮经肝穿刺胆道引流(PTCD)+球囊扩张治疗(PTCD组)。对比两组病人一般资料、治疗相关参数及随访结果。结果 腹腔镜组诊断BBEAS时间晚于PTCD组,余术前资料两组类似。两种方式治疗BBEAS的成功率(10/11 vs. 12/13,χ2=0.15,P=0.9)及相关并发症发生率(1/10 vs. 11/57,χ2=0.5,P=0.48)类似,但腹腔镜组在治疗所需中位时间(14 d vs. 161 d,Z=-3.5,P=0)、所需平均治疗次数(1.0次/例 vs. 4.4次/例,T=-6.4,P=0)明显少于PTCD组。术后随访26.0±10.8个月,两组吻合口狭窄复发比例(1/10 vs. 4/12,χ2=1.7,P=0.19)差异无统计学意义。结论 腹腔镜下再次胆肠吻合术治疗良性胆肠吻合口狭窄安全、效果良好。
关键词: 腹腔镜, 胆肠吻合狭窄, 二次手术, 经皮经肝胆道引流, 狭窄复发
李 宇1,张军强2,王 铮1,仵 正1,吕 毅1,刘学民1. 腹腔镜下再次胆肠吻合治疗良性胆肠吻合口狭窄探讨[J]. 中国实用外科杂志, DOI: 10.19538/j.cjps.issn1005-2208.2020.11.21.
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https://www.zgsyz.com/zgsywk/EN/Y2020/V40/I11/1314