Abstract:

Clinical analysis and strategies of 23 cases of secondary cholangioenterostomy        CHEN Yi-gang, BAI Xue-li, MA Tao, et al. Department of Hepatopancreatobiliary Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
Corresponding author：LIANG Ting-bo, E-mail：liangtingbo@zju.edu.cn
Abstract    Objective    To explore the causes, method and surgical related complications of the secondary surgical procedure，and propose preventive strategies of the cholangioenterostomy-related serious postoperative complications. Methods    The clinical data of 23 cases of secondary cholangioenterostomy performed from January 2012 to March 2016 in the Department of Hepatopancreatobiliary Surgery, the Second Affiliated Hospital of Zhejiang University were analyzed retrospectively. The clinical characteristics of cholangioenterostomy including causes, operative procedures and their complications were compared. Results    The causes of secondary cholangioenterostomy mainly include anastomotic stricture (14 cases , 60.9%), cholelithiasis (13 cases, 56.5%), cholangitis (10 cases, 43.5%). Secondary cholangioenterostomy is standardized as cholangiojejunostomy Roux-en-Y anastomosis and patients neither died in the perioperation nor need to receive operation again because of anastomotic stricture. Conclusion    The causes of secondary cholangioenterostomy are diverse and complicated. Preoperatively, surgeons should follow the surgical indication strictly. Intraoperatively, cholangiojejunostomy Roux-en-Y anastomosis should be chosen and surgeons are required to remove the primary lesions (tumor, cyst, lithiasis,etc.) completely in order to prevent or reduce the cholangioenterostomy-related serious postoperative complications, and finally reduce the rate of reoperation.

Key words: cholangiojejunostomy, biliary-duodenal anastomosis, secondary operation, anastomotic stricture, complication

摘要：

目的    探讨胆肠吻合术后二次胆肠吻合的原因、术式及手术相关并发症的特点，提出预防胆肠吻合术后严重并发症导致二次手术的对策。方法    回顾性分析浙江大学医学院附属第二医院肝胆胰外科2012年1月至2016年3月23例二次胆肠吻合术病例的临床资料，比较两次术前诊断、手术方式及术后并发症的临床特点。
结果    胆肠吻合术后二次胆肠吻合术前诊断主要有：吻合口狭窄14例（60.9%），胆管结石13例（56.5%），胆管炎10例（43.5%）；第二次胆肠吻合均采用胆管-空肠Roux-en-Y吻合，术后无围手术期死亡或需再次手术病例。结论    第二次胆肠吻合手术原因较多，术前严格把握手术指征，术中选用胆管-空肠Roux-en-Y吻合，可预防、减少或减轻胆肠吻合术后相关严重并发症，减少潜在的再次手术发生。

关键词: 胆管空肠吻合, 胆管十二指肠吻合, 二次手术, 吻合口狭窄, 并发症