Twenty one cases of hepatocholelithiasis treated through hepatic round ligament approach for hepaticojejunostomy is reported. Of them 5 were introgenic injury to the biliary tract， 8 were left hepatolithiasis (7 complicated with bile duct stricture), 2 were intrahepatic sandy stone with acute suppurative cholangeitis, and 3 were residual stone in left hepatic duct with cystlike dilatation after T-tube drainage; while traumatic injury to the biliary passages, previous multiple biliary tract operations and left hepatic duct stone with acute hemorrhage were present in one of case individually 75.9% each. The ages of the patients were between 32 to 50 years. Clinical follw-up in this series was satisfactory. The authors consider that this approach gives good exposure with little injury to the liver and no liver resection needed. The indication for this approach mode of anastomosis and some operative details are discussed.
目的探讨如何降低胰十二指肠切除术后胰空肠吻合口漏的发生。方法采用胰管空肠吻合胰腺残端套入法行胰肠吻合，按胰、胆、胃顺序与空肠重建消化道。结果27例胰十二指肠切除术中，手术并发症7例（25.93%），其中应激性溃疡出血3例，胃排空延迟2例，腹腔及腹壁创口感染各1例，均经非手术治愈。全组无围手术期死亡，亦无一例发生胰瘘。结论胰瘘的发生同术式和操作技术密切相关，亦与吻合口部位血供和张力以及吻合口远端通畅与否有关。本术式增加了胰空肠吻合的严密性，对预防胰瘘的发生起到了积极的效果，且操作简便，易于掌握，效果可靠。