CAJ | 학술논문

目的　探讨胆肠吻合术后再手术的原因及处理方法。方法　回顾性分析1995年6月～1999年6月间28例胆肠吻合术后再手术的临床资料。结果　28例中，吻合口狭窄26例(92.8%)，伴左肝管狭窄9例，右肝管狭窄3例，左右肝管狭窄5例。钡餐造影9例见胆管内返流，均为胆总管十二指肠吻合者。再手术方法：原吻合口切除再吻合3例，左肝外叶切除、肝门胆管整形与空肠Roux-en-Y吻合8例，左肝管、肝门胆管与空肠双口吻合2例，肝内胆管狭窄切开并整形后与空肠Roux-en-Y吻合15例。26例(92.8%)随访0.5-4年，仅1例(3.8%)间有轻度感染症状。结论　胆肠吻合口狭窄是再手术的根本原因，其次是术式选择不当、肝胆管狭窄未予解除及结石清除不彻底。再手术时应遵循清除结石、解除狭窄及通畅引流的原则，必要时结合肝段(叶)切除、吻合口支撑引流及术中、术后胆道镜处理。
목적　탐토담장문합술후재수술적원인급처리방법。방법　회고성분석1995년6월～1999년6월간28례담장문합술후재수술적림상자료。결과　28례중，문합구협착26례(92.8%)，반좌간관협착9례，우간관협착3례，좌우간관협착5례。패찬조영9례견담관내반류，균위담총관십이지장문합자。재수술방법：원문합구절제재문합3례，좌간외협절제、간문담관정형여공장Roux-en-Y문합8례，좌간관、간문담관여공장쌍구문합2례，간내담관협착절개병정형후여공장Roux-en-Y문합15례。26례(92.8%)수방0.5-4년，부1례(3.8%)간유경도감염증상。결론　담장문합구협착시재수술적근본원인，기차시술식선택불당、간담관협착미여해제급결석청제불철저。재수술시응준순청제결석、해제협착급통창인류적원칙，필요시결합간단(협)절제、문합구지탱인류급술중、술후담도경처리。
Objective　To study the causes and management of the reoperation after cholangiointestiostomy(CIS). Methods　A retrospective analysis was made on the clinical data of 28 cases of reoperation after CIS from June 1995 to June 1999. Results　Among the 28 cases, 26 cases(92%) had CIS anastomotic stenosis. Of the 26 cases, 9 cases accompanied with left hepatobiliary duct stenosis, 3 cases with right hepatobiliary duct stenosis, 5 cases with left and right hepatobiliary ducts stenosis. 9 cases with biliary reflux comfirmed by barium meal radiography, all of the 9 cases were subjected to a choleduodenostomy. Of the 28 patients, 3 underwent reanastomose after excision the primary anstomosis, 8 operated with hilar bile duct reform and left lateral hepatolobectomy, 2 with left hepatic duct jejunostomy and hilar bile duct jejunostomy. 15 cases with intrahepatic bile duct jejunal Roux-en-Y anastomosis, after resolved the intrahepatic bile duct stenosis. Conclusions　The basic cause of reoperation after CIS is anastomotic stenosis, the other causes are as follows: the selected operation is unsuitable, the intrahepatic bile duct stenosis is not resolved, and the stonedoes not clean out completly. When reoperation is performed on these cases, the following principles must be abided by: romoving all the stones, resolving the stenosis, making a clear drainage; and performing hepatic lobectomy, anastomotic sustaining and drainage, and cholefibroscopic management must be done if needed.