摘要
目的探讨经皮经肝胆道镜(PTCS)治疗胆肠吻合术后吻合口良性狭窄的可行性和有效性。方法回顾性分析2016年4月至2020年4月于浙江大学医学院附属第二医院肝胆胰外科因考虑胆肠吻合术后吻合口狭窄行PTCS下扩张成形、肝内胆管取石治疗的9例患者的临床资料。男性7例,女性2例,年龄40~76岁。该手术分为两期,一期行超声引导下经皮肝内胆管穿刺,置入鞘管固定,二期待窦道形成后经皮胆道镜行吻合口狭窄钬激光+球囊扩张术。治疗后通过肝胆相关生化指标等评估治疗效果。结果9例患者的手术时间为(53.3±31.0)min(范围:15~120 min),术后住院时间为(4.4±2.3)d(范围:2~9 d)。经治疗后,9例患者术前腹痛、黄疸、发热寒战等症状消失;术前碱性磷酸酶为122~1334 U/L,术后为85~702 U/L;术前γ-谷氨酰转肽酶为44~1219 U/L,术后为46~529 U/L。结论PTCS手术治疗过程安全,可有效扩张胆肠吻合口狭窄,是治疗胆肠吻合口狭窄的可选术式。
Objective To investigate the feasibility and effectiveness of percutaneous transhepatic cholangioscopy(PTCS)in the treatment of bilioenteric anastomotic stricture after choledochojejunostomy.Methods From April 2016 to April 2020,the clinical data of 9 patients(7 males and 2 females,aged 40-76 years)who underwent percutaneous transhepatic cholangioscopy(PTCS)for stricture expansion and lithotomy at Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed.The operation was divided into two stages.In the first stage,ultrasound-guided percutaneous intrahepatic bile duct puncture was performed,and the sheath tube was inserted and fixed.In the second stage,percutaneous choledochoscopy was used for anastomotic stricture after sinus formation.The clinical outcome was evaluated by related biochemical indexes.Results The operation time was(53.3±31.0)minutes(range:15-120 minutes).The postoperative hospital stay was(4.4±2.3)days(range:2-9 days).After systematic treatment,the preoperative symptoms,such as abdominal pain,jaundice,fever and shivering,disappeared in 8 patients.The range of alkaline phosphatase was 122-1334 U/L before operation and 85-702 U/L after operation.The range of gamma glutamyl transpeptidase was 44-1219 U/L before operation and 46-529 U/L after operation.Conclusion PTCS is a safe and effective option for minimally invasive treatment of bilioenteric anastomotic stricture.
作者
朱沂
赵华
谢敏杰
李亮平
金晶
楼健颖
Zhu Yi;Zhao Hua;Xie Minjie;Li Liangping;Jin Jing;Lou Jianying(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第4期289-292,共4页
Chinese Journal of Surgery
基金
国家自然科学基金(81702316)
浙江省教育厅课题(Y201328151)
浙江省医药卫生科技卫生项目(2018262381)。
关键词
外科吻合口
手术后并发症
胆肠吻合口狭窄
经皮经肝胆道镜
Surgical stomas
Postoperative complications
Bilioenteric anastomotic stricture
Percutaneous transhepatic cholangioscopy
