机器人辅助胆肠再吻合治疗胆肠吻合术后良性胆道狭窄:单中心技术经验与手术策略
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湖南师范大学附属第一医院(湖南省人民医院) 肝胆胰外科,湖南 长沙 410005

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李云峰,湖南师范大学附属第一医院(湖南省人民医院)主任医师,主要从事肝胆胰疾病微创外科及机器人辅助手术方面的研究。

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Robot-assisted redo bilioenteric anastomosis for benign biliary strictures: technical experience and surgical strategies from a single center
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Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha 410005, China

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    摘要:

    胆肠吻合术后良性胆道狭窄是胆道重建术后的重要远期并发症,严重者可导致胆汁淤积、反复胆管炎、肝内胆管结石及继发性肝功能损害。对于内镜或经皮介入治疗失败、不适合介入治疗,或伴严重瘢痕性狭窄、高位多支胆管受累及复杂肝内胆道病变的患者,胆肠再吻合仍是恢复长期有效胆汁引流的重要治疗方式。机器人手术具有三维放大视野、腕式器械及精细缝合等技术优势,为复杂胆道重建提供了新的微创手术选择。本文结合相关文献及本中心临床实践,对机器人辅助胆肠再吻合治疗胆肠吻合术后良性胆道狭窄的病例选择、术前评估、Trocar布局、腹腔粘连松解、肝门显露、胆管切开整形、胆肠盆式内引流、围手术期处理及术后随访等关键环节进行系统总结,并重点归纳复杂胆道再重建过程中降低吻合口张力、保护胆管血供、扩大有效引流面及实现黏膜精准对合的技术要点。机器人辅助胆肠再吻合可为部分复杂胆肠吻合术后良性胆道狭窄患者提供可行的微创重建方案,但其应用应建立在严格病例选择、充分术前评估及成熟胆道重建技术基础上,且其长期疗效及相较其他术式的优势仍需更多高质量临床研究进一步验证。

    Abstract:

    Benign biliary stricture following bilioenteric anastomosis is an important late complication of biliary reconstruction and may result in cholestasis, recurrent cholangitis, intrahepatic bile duct stones, and secondary hepatic dysfunction. For patients with failed or unsuitable endoscopic or percutaneous interventions, particularly those with severe cicatricial strictures, high hilar or multifocal biliary involvement, or complex intrahepatic biliary disease, redo bilioenteric anastomosis remains an important option for restoring durable biliary drainage. With its three-dimensional magnified visualization, wristed instruments, and enhanced suturing capability, robotic surgery provides a potential minimally invasive approach for complex biliary reconstruction. Based on the relevant literature and our institutional experience, we systematically summarize the key aspects of robot-assisted redo bilioenteric anastomosis for benign biliary strictures after bilioenteric anastomosis, including patient selection, preoperative assessment, trocar placement, adhesiolysis, hilar dissection, bile duct incision and ductoplasty, basin-like bilioenteric drainage reconstruction, perioperative management, and postoperative follow-up. Particular attention is given to technical principles for reducing anastomotic tension, preserving bile duct vascularity, creating a wide and effective drainage surface, and achieving precise mucosa-to-mucosa apposition during complex biliary reconstruction. Robot-assisted redo bilioenteric anastomosis may provide a feasible minimally invasive reconstructive option for selected patients with complex benign biliary strictures after bilioenteric anastomosis. Its application should, however, be based on strict patient selection, comprehensive preoperative assessment, and adequate expertise in complex biliary reconstruction, while its long-term efficacy and potential advantages over other surgical approaches require further validation in high-quality clinical studies.

    图1 机器人辅助胆肠再吻合术的Trocar布局Fig.1 Trocar placement for robot-assisted redo bilioenteric anastomosis
    图2 机器人辅助腹腔粘连松解及肝门显露的关键步骤 A:马里兰双极钳联合单极电剪刀行腹腔粘连松解;B:上腹部既往手术区域瘢痕及粘连组织;C:下降肝门板显露肝门胆管Fig.2 Key steps of robot-assisted adhesiolysis and hilar dissection A: Robot-assisted adhesiolysis using Maryland bipolar forceps combined with monopolar scissors; B: Fibrotic scar tissue and adhesions in the upper abdominal surgical field after previous surgery; C: Lowering the hilar plate to expose the hilar bile ducts
    图3 机器人辅助胆肠吻合口狭窄解除及肝门部胆管整形的关键步骤 A:狭窄的胆肠吻合口;B:单极电剪切开狭窄胆肠吻合口;C:钝性扩张胆管开口;D:锐性纵向切开胆管;E:单极电剪刀电切胆管;F:胆管切开整形后的肝门胆管开口Fig.3 Key steps of robot-assisted release of bilioenteric anastomotic stricture and hilar bile ductoplasty A: Stenotic bilioenteric anastomosis; B: Incision of the stenotic bilioenteric anastomosis using monopolar scissors; C: Blunt dilation of the bile duct opening; D: Sharp longitudinal incision of the bile duct; E: Electrosurgical incision of the bile duct; F: Hilar bile duct opening after incision and ductoplasty
    图4 机器人辅助胆肠吻合口重建的关键步骤 A:游离空肠袢;B:离断系膜血管,降低吻合口张力;C:重建胆肠吻合口后壁;D:重建胆肠吻合口前壁;E:完成胆肠吻合口重建; F:胆肠吻合口两侧悬吊固定肠管Fig.4 Key steps of robot-assisted reconstruction of the bilioenteric anastomosis A: Mobilization of the Roux-en-Y jejunal limb; B: Selective division of mesenteric vessels to increase jejunal limb mobility and reduce anastomotic tension; C: Reconstruction of the posterior wall of the bilioenteric anastomosis; D: Reconstruction of the anterior wall of the bilioenteric anastomosis; E: Completion of bilioenteric anastomotic reconstruction; F: Suspension fixation of the jejunal limb on both sides of the bilioenteric anastomosis
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陈冠羽,王曦滔,谭建,李云峰.机器人辅助胆肠再吻合治疗胆肠吻合术后良性胆道狭窄:单中心技术经验与手术策略[J].中国普通外科杂志,2026,35(8):1529-1541.
DOI:10.7659/j. issn.1005-6947.260379

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  • 收稿日期:2026-06-29
  • 最后修改日期:2026-08-13
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  • 在线发布日期: 2026-09-29
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