目的:探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）致胆管损伤的原因、预防措施和经验教训。方法:分析2007年8月～2008年8月期间我院胆道外科收治的3例胆管严重损伤病例资料。结果:3例LC术致胆管严重损伤的患者均发生肝门部胆管狭窄，并均在肝门胆管成形后行胆管空肠Roux-en-Y吻合术，吻合口直径2.0～3.0 cm。术后患者恢复良好，均顺利出院，住院时间为10～15天。随访1～6个月，1例于术后2月出现肝区隐痛，口服消炎药可控制，其余未见异常不适。结论:术中仔细辩清肝总管、胆总管与胆囊管的三者关系是预防LC术胆管损伤的关键。胆管空肠Roux-en-Y吻合术是处理胆管损伤的重要手术方式。LC术时，胆道外科医生思想上要高度重视，不可盲目追求速度。
Objective To investigate the best management in treating relapsed biliary calculi after endoscopic sphincterotomy (EST).Methods The clinical data of 96 patients with relapsed biliary calculi after EST in our hospital from February 1999 to February 2009 were retrospectively analysed. The patients were grouped into two groups by the size of calculi under magnetic resonance cholangiopancreatography: surgical group (the size of calculi was bigger than 1.0 cm) in 79 cases and non-surgical group (the size of stone was smaller than 1.0 cm and the patients were performed EST again) in 17 cases. The relapsed biliary calculi rate between two groups were compared. Results In the surgical group, the 79 patients (82.29%) were performed common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis. In the non-surgical group, the 17 patients (17.17%) were performed EST again. The relapsed biliary calculi rate was 2.63% in the surgical group, 70.59% in the non-surgical group. There was marked difference in the relapsed biliary calculi rate between surgical group and non-surgical group (Plt;0.05). Conclusion The operation treatment is the best way for relapsed biliary calculi after EST, and has good curative effect. The best manner of operation treatment is common bile duct exploration, transected common bile duct and choledochojejunostomy with Roux-en-Y anastomosis.
ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.
目的 总结胰腺瘘管空肠Roux-en-Y吻合术治疗胰管离断综合征的治疗效果。方法 回顾性分析2002年3月至2010年7月期间我院行胰腺瘘管空肠Roux-en-Y吻合术治疗的5例胰管离断综合征患者的临床资料，分析其治疗效果及手术并发症。结果 5例患者均为急性出血坏死性胰腺炎手术治疗后，经MRCP确诊为胰管离断综合征，手术方式为瘘管空肠Roux-en-Y吻合术，中位手术时间为178min（120～360min），中位术中失血量为300ml（150～600ml），术后中位进食时间为5d（3～8d）。随访中位时间为390d（120～712d），5例患者恢复顺利。2例患者切口感染，经切口换药治愈；1例患者出现短暂的胰肠吻合口漏，经保守治疗治愈。结论 从本组有限的病例资料看，胰腺瘘管空肠Roux-en-Y吻合术是胰管离断综合征较安全的治疗方式。
目的 探讨全胃切除术后消化道重建方式的选择。 方法 我院2001年6月至2006年6月期间对182例胃癌患者全胃切除术后分别行空肠ρ袢代胃术(PRY)69例和非离断式食管空肠改良Roux-en-Y吻合术(URY)113例。 分析手术时间、术后进食情况、消化道症状及营养状况的差异。结果 非离断式食管空肠改良Roux-en-Y吻合术手术时间短于空肠ρ袢代胃术，且无Roux潴留综合征（RSS）发生。 2种术式术后患者营养状况并无明显差异。结论 非离断式食管空肠改良Roux-en-Y吻合术操作简单、并发症少、术后恢复良好，可以推荐作为全胃切除术后的消化道重建术式。