Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, USA.
J Gastrointest Surg. 2012 Apr;16(4):801-5. doi: 10.1007/s11605-011-1768-3. Epub 2012 Jan 31.
With the advent of endoscopic retrograde choledochoduodenostomy, the need for choledochoduodenostomy to treat common bile duct obstruction is less common, but occasionally required.
Patients considered for laparoscopic choledochoduodenostomy secondary to benign conditions between 1999 and 2009 at a single institution were included. Charts were retrospectively reviewed for preoperative, operative, and long-term outcomes data.
Twenty patients were identified; 15 with chronic choledocholithiasis causing benign biliary obstruction or chronic recurrent cholangitis, 3 with chronic relapsing pancreatitis, and 2 with distal common bile duct strictures. Mean operative time was 270 min. No major operative complications were reported. Five patients with severe adhesions or portal hypertension required conversion to laparotomy. Median hospital stay was 6 days (range, 2-32). Postoperatively, three (20%) patients completed laparoscopically and three (66.7%) patients converted to laparotomy had complications. In addition, one death due to myocardial infarction was reported 4 weeks after hospital discharge. With an average follow-up of 21 months, only one patient (5%) developed recurrent symptoms.
Laparoscopic choledochoduodenostomy is a useful technique in patients with benign, refractory common bile duct obstruction. This technically demanding procedure is feasible; however, the associated comorbidities in this complex group of patients result in a relatively high complication rate.
随着内镜逆行胰胆管造影术（endoscopic retrograde choledochoduodenostomy，简称 ERCP）的出现，治疗胆总管梗阻的需要已经减少，但偶尔仍需进行胆肠吻合术（choledochoduodenostomy）。
在单家机构，对 1999 年至 2009 年间因良性疾病而考虑行腹腔镜胆肠吻合术的患者进行研究。回顾性分析患者的术前、术中及长期结局数据。
共纳入 20 例患者，其中 15 例因慢性胆总管结石导致良性胆道梗阻或慢性复发性胆管炎，3 例因慢性复发性胰腺炎，2 例因胆总管下段狭窄。平均手术时间为 270 分钟。无重大手术并发症报告。5 例因严重粘连或门脉高压而需要转为开腹手术。中位住院时间为 6 天（范围为 2-32 天）。术后，3 例（20%）患者顺利完成腹腔镜手术，3 例（66.7%）转为开腹手术的患者出现并发症。此外，1 例患者在出院后 4 周因心肌梗死死亡。平均随访 21 个月，仅 1 例（5%）患者出现复发症状。
腹腔镜胆肠吻合术是治疗良性、难治性胆总管梗阻的有效技术。该技术要求较高，但该复杂患者群体的相关合并症导致较高的并发症发生率。
