摘要
目的:探讨内镜下磁压榨胆肠吻合术治疗腹部复杂手术后胆道梗阻的临床疗效。方法:采用回顾性描述性研究方法。收集2012年1月至2019年12月西安交通大学第一附属医院收治的3例腹部复杂手术后胆道梗阻患者的临床资料;男2例,女1例;中位年龄为56岁,年龄范围为27~57岁。3例患者术前经多次内镜或介入治疗均失败,采用内镜下磁压榨胆肠吻合完成胆道内引流治疗。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊方式进行随访,了解患者胆道支架、肝功能和吻合口通畅情况。随访时间截至2019年12月。结果:(1)手术情况:3例患者顺利完成内镜下磁压榨胆肠吻合术,其中磁压榨胆道十二指肠吻合2例,磁压榨胆道空肠吻合1例;术前胆道狭窄长度分别为7.1 mm、3.0 mm、2.0 mm,磁装置大小(子磁体直径/母磁体直径)为7 mm/8 mm、6 mm/6 mm、5 mm/5 mm,磁压榨手术操作时间分别为130 min、90 min、75 min。(2)术后情况:3例患者分别在术后15 d、8 d、9 d恢复胆道再通,无消化道穿孔、出血及感染等并发症发生。(3)随访情况:3例患者胆道再通后放置胆道支架跨越新吻合口,分别为12 Fr经皮经肝胆管引流导管、7 Fr胆道塑料支架、14 Fr经皮经肝胆管引流导管,术后17个月、2个月、6个月后拔除支架。3例患者拔除支架后分别随访40个月、20个月、5个月,总胆红素为5~19μmol/L,天冬氨酸氨基转移酶为25~40 U/L,丙氨酸氨基转移酶为20~35 U/L。超声或磁共振胰胆管造影检查未提示肝内胆管扩张,无胆肠吻合口狭窄复发。1例患者在拔除支架后37个月因胆道感染入院,超声及磁共振胰胆管造影检查示肝内胆管结石;行内镜清除胆道结石,内镜及胆道造影检查未见胆肠吻合口狭窄。结论:内镜下磁压榨胆肠吻合术治疗常规方法治疗无效的腹部复杂手术后胆道梗阻,手术方式安全可行,远期疗效较好。
Objective:To investigate the clinical efficacy of endoscopic magnetic compression bilio-enteric anastomosis for the treatment of biliary obstruction after complex abdominal surgery.Methods:The retrospective and descriptive study was conducted.The clinical data of 3 patients with biliary obstruction after complex abdominal surgery who were admitted to the First Affiliated Hospital of Xi′an Jiaotong University between January 2012 and December 2019 were collected.There were 2 males and 1 female,aged from 27 to 57 years,with a median age of 56 years.The 3 patients underwent endoscopic magnetic compression bilio-enteric anastomosis to complete internal drainage of bile ducts after several unsuccessful endoscopic or interventional therapy.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Follow up using outpatient examination was performed to detect the biliary stent,liver function and patency of anastomotic stoma up to December 2019.Results:(1)Surgical situations:all the 3 patients underwent successful endoscopic magnetic compression bilio-enteric anastomosis,including 2 cases with magnetic compression choledochoduodenal anastomosis and 1 case with magnetic compression choledochojejunostomy.The length of biliary stricture,length and width of magnetic device subsidiary magnet/patent magnet,time of magnetic compression for the 3 patients were 7.1 mm,3.0 mm,2.0 mm,7 mm/8 mm,6 mm/6 mm,5 mm/5 mm,130 minutes,90 minutes,75 minutes,respectively.(2)Postoperative situations:the time to biliary tract recanalization after operation for the 3 patients were 15 days,8 days,9 days,respectively.None of the patients encountered gastrointestinal perforation,hemorrhage or infection.(3)Follow-up:the biliary stents were inserted into the anastomotic stoma for the 3 patients after biliary tract recanalization,including a catheter of percutaneous transhepatic cholangiodrainage(PTCD)with 12 Fr size,a biliary plastic stent with 7 Fr size,a catheter of PTCD with 14 Fr size,respectively.The biliary stents were removed after 17 months,2 months,and 6 months from the 3 patients,respectively.The 3 patients were followed up for 40 months,20 months,and 5 months respectively after removing biliary stents,and the concentration of total bilirubin,concentration of aspartate aminotransferase,concentration of alanine aminotransferase for the 3 patients were 5-19μmol/L,25-40 U/L,and 20-35 U/L,respectively.The results of ultrasonic examination or magnetic resonance cholangiopancreatography examination showed that no intra-hepatic bile duct dilation or stricture of choledochojejunostomy was found within the 3 patients.One of the 3 patients was hospitalized for biliary tract infection after 37 months from removing biliary stents,and the results of ultrasonic examination or magnetic resonance cholangiopancreatography examination showed intrahepatic cholelithiasis.The cholelithiasis was removed under endoscopy and stricture of choledochojejunostomy was not found within patient by the endoscopic examination or cholangiography examination.Conclusion:The endoscopic magnetic compression bilio-enteric anastomosis is a safe and feasible technique for the treatment of biliary obstruction after complex abdominal surgery with good long-term effects.
作者
李宇
朱浩阳
孙昊
刘学民
张晓刚
王博
吕毅
Li Yu;Zhu Haoyang;Sun Hao;Liu Xuemin;Zhang Xiaogang;Wang Bo;Lyu Yi(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;National Local Joint Engineering Research Center for Precision Surgery&Regenerative Medicine,Xi′an 710061,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2020年第5期544-551,共8页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81470896)
陕西省科技资源开放共享平台项目(2016FWPT-01)。
关键词
胆道梗阻
磁压榨吻合
胆道空肠吻合
胆道十二指肠吻合
微创
Biliary obstruction
Magnetic compression anastomosis
Choledochojejunostomy
Choledochoduodenostomy
Minimal invasive
