Symeonidis Dimitrios, Paraskeua Ismini, Samara Athina A, Bompou Effrosyni, Valaroutsos Alexandros, Ntalouka Maria P, Zacharoulis Dimitrios
Department of Surgery, University Hospital of Larissa, 41100 Larisa, Greece.
Department of Anesthesiology, University Hospital of Larissa, 41100 Larisa, Greece.
Medicines (Basel). 2023 May 11;10(5):31. doi: 10.3390/medicines10050031.
Primary sclerosing cholangitis sets the scene for several pathologies of both the intrahepatic and the extrahepatic biliary tree. Surgical treatment, when needed, is almost unanimously summarized in the creation of a Roux-en-Y hepaticojejunostomy, a procedure with a relatively high associated failure rate. : A 70-year-old male, diagnosed with primary sclerosing cholangitis, was submitted to a Roux-en-Y hepaticojejunostomy due to a dominant stricture of the extrahepatic biliary tree. Recurrent episodes of acute cholangitis dictated a workup in the direction of a possible stenosis at the level of the anastomosis. The imaging studies were inconclusive while both the endoscopic and the transhepatic approach failed to assess the status of the anastomosis. A laparotomy, with the intent to revise a high suspicion for stenosis hepaticojejunostomy, was decided. Intraoperatively, a decision to assess the hepaticojejunostomy prior to the scheduled surgical revision, via endoscopy, was made. In this direction, an enterotomy was made on the short jejunal blind loop in order to gain luminal access and an endoscope was propelled through the enterotomy towards the biliary enteric anastomosis. The inspection of the anastomosis under direct endoscopic vision showed no evidences of stenosis and averted an unnecessary, under these circumstances, revision of the anastomosis. The surgical revision of a Roux-en-Y hepaticojejunostomy is a highly demanding operation with an increased associated morbidity, and it should be reserved as the final resort in the treatment algorithm. An approach of utilizing surgery to facilitate the endoscopic assessment prior to proceeding to the surgical revision of the anastomosis appears justified.
原发性硬化性胆管炎是肝内和肝外胆管树多种病变的发病基础。手术治疗（如有必要）几乎一致采用Roux-en-Y肝空肠吻合术，该手术相关失败率相对较高。一名70岁男性，诊断为原发性硬化性胆管炎，因肝外胆管树的主导性狭窄接受了Roux-en-Y肝空肠吻合术。急性胆管炎反复发作，提示需对吻合口处可能存在的狭窄进行检查。影像学检查结果不明确，而内镜和经肝途径均未能评估吻合口的状况。于是决定进行剖腹手术，旨在修正高度怀疑的肝空肠吻合口狭窄。术中，决定在预定的手术修正之前，通过内镜评估肝空肠吻合口。为此，在空肠短盲袢上做了一个肠切开术以获得腔内通路，并将内窥镜经肠切开术推进至胆肠吻合口。在内镜直视下对吻合口的检查未发现狭窄迹象，避免了在这种情况下不必要的吻合口修正。Roux-en-Y肝空肠吻合术的手术修正术是一项要求很高的手术，相关发病率增加，应作为治疗方案中的最后手段保留。在进行吻合口的手术修正之前，利用手术辅助内镜评估的方法似乎是合理的。
