目的 探讨胆管空肠Roux-Y吻合术后再手术技术性的原因及处理.方法 回顾性分析2004年1月至2010年3月间17例因指征选择及术式实行不当致胆管空肠Roux-Y吻合术后再手术患者的临床资料.结果 术中见胆肠吻合口狭窄及肝内外胆管狭窄13例,伴结石形成10例;返流性胆管炎7例.原肠肠吻合呈T形3例、倒Y形2例,上行肠襻25cm、70cm各1例,结肠前位4例;胆肠侧侧吻合3例、端端吻合4例、侧端吻合3例、端侧吻合7例.拆除原胆肠吻合口或原肠肠吻合口改为规范的吻合5例.切除胆总管囊肿行胆管空肠Roux-Y吻合2例;胆肠吻合口扩大,整形或盆式吻合4例.拆除原胆肠吻合口、恢复胆管结构,T管引流3例.左肝外叶或左半肝切除3例.15例随访时间平均31.2月,4例有胆管炎表现.结论 严格地把握胆肠吻合的适应证、实行规范的胆肠吻合术及提高手术技巧是减少Roux-Y胆肠吻合再手术技术性原因的关键;再手术时需采用个体化的手术方案.%Objective To study the technical causes and management of reoperation after Roux-Y cholangioenterostomy. Methods A retrospective analysis was made on the clinical data of 17 patients who underwent reoperation after Roux-Y cholangioenterostomy from January 2004 to March 2010 because of improper indication choice and surgical strategies. Results During the operation, stricture of chole - intestinal stoma and of extrahepatic and intrahepatic ducts was found in 13 patients, among which, 10 patients were complicated with stones. Reflux cholangitis was seen in 7 patients. Intest-intestinal stoma presented "T" in shape in 3 patients and"Y" in shape in 2 patients. The upper ansa interstinalis were 25 cm in 1 patient,70 cm in another patient and anteposition of colon was found in 4 cases. Side to side anastomosis of chole - intestine was found in 3 patients, end to end in 4 patients, side to end in 3 patients and end to side in 7 patients. Of the 17 patients,5 were subjected to renanastomosis after dismantling the primary anastomosis,2 to choledochocystectomy,4 to renanastomosis after enlarging the primary anastomosis,3 to recovering normal bile path with T tube drainage and 3 to hepatolobectomy. The follow - up for the 17 patients averaged 31.2 months,showing that 4 patients still had cholangitis. Conclusion Strictly selecting surgical indications,performing proper cholangioenterostomy and improving operative skills are the key to reduce reoperation attributed to technical causes. Individualized surgical program is needed in the reoperation.
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