Cheng Zhang-Bin, Xu Ding-Wei, Huang Haoyao, Song Guangna, Huang Jie
Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China.
Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 243 Dianmian Avenue, Wuhua District, Kunming, 650102, Yunnan, China.
Sci Rep. 2025 Sep 1;15(1):32221. doi: 10.1038/s41598-025-18113-8.
Roux-en-Y hepaticojejunostomy is a crucial procedure for treating biliary diseases, especially in patients with recurrent hepatolithiasis. However, the safety and efficacy of repeat laparoscopic Roux-en-Y hepaticojejunostomy(R-LRHJS) remain controversial due to the complexity of hepatobiliary stones and the potential for complications. A total of 41 patients admitted to the Department of Hepatobiliary Surgery at the Second Affiliated Hospital of Kunming Medical University from June 2019 to December 2023 were reviewed. 20 patients who underwent repeat R-LRHJS were included in the final analysis. Surgical techniques emphasized meticulous dissection of intra-abdominal adhesions, precise identification of the hepatic hilum bile duct, and careful reconstruction of the biliary-enteric anastomosis. The mean patient age was 54.6 ± 10.7 years. Operative time ranged from 120 to 378 min, with intraoperative blood loss between 10 and 200 ml. Postoperative complications included anastomotic bleeding (2 cases), pancreatic stump bleeding (1 case), duodenal fistula (1 case), and biliary leakage (5 cases). No perioperative deaths occurred. During a 1- to 3-year follow-up, no recurrence of anastomotic stenosis or stone formation was observed on MRCP. The study concludes that R-LRHJS is a feasible and effective treatment for recurrent biliary strictures or stones following initial choledochojejunostomy.
Roux-en-Y肝空肠吻合术是治疗胆道疾病的关键手术，尤其适用于复发性肝内胆管结石患者。然而，由于肝胆结石的复杂性和并发症的可能性，重复腹腔镜Roux-en-Y肝空肠吻合术（R-LRHJS）的安全性和有效性仍存在争议。回顾了2019年6月至2023年12月在昆明医科大学第二附属医院肝胆外科住院的41例患者。最终分析纳入了20例行重复R-LRHJS的患者。手术技术强调仔细解剖腹腔内粘连；精确识别肝门胆管；并仔细重建胆肠吻合。患者平均年龄为54.6±10.7岁。手术时间为120至378分钟，术中出血量为10至200毫升。术后并发症包括吻合口出血（2例）、胰残端出血（1例）、十二指肠瘘（1例）和胆漏（5例）。无围手术期死亡。在1至3年的随访中，磁共振胰胆管造影（MRCP）未观察到吻合口狭窄或结石形成的复发。该研究得出结论，R-LRHJS是治疗初次胆总管空肠吻合术后复发性胆管狭窄或结石的一种可行且有效的方法。
