2020年 · 第58卷第10期

magnetic compression anastomosis (MCA) is a wireless anastomosis technique using magnetic force between magnets^[1,2]。 In recent ten years, with the emergence of new magnetic materials such as samarium cobalt and rare earth neodymium iron boron materials, the clinical application of MCA has gradually increased. We previously used MCA to complete open biliary enteromagnetic anastomosis^[3]Magnetic anastomosis of pancreas and intestine^[4]The operation is simple, and no gastrointestinal fistula occurs after operation. We have recently developed a special magnetic stapler for biliary intestine^[5]The external bile drainage of the original magnetic device is changed to internal bile drainage, which meets the physiological requirements and is more convenient to operate. In 2017, we began to apply this stapler in clinic, and now retrospectively analyze the safety and effectiveness of this stapler in clinical biliary enterostomy.

Gallbladder cancer is highly malignant, often directly invading or involving surrounding organs through lymphatic metastasis, and most of them are advanced at the time of consultation (AJCC 8th Edition Staging System Stage III ~ IV). About 50% of patients with gallbladder cancer will develop jaundice during the course of the disease, or jaundice is the first symptom. Usually jaundice is considered to be a late symptom with a very poor prognosis, with an average survival time of approximately 3 months untreated^[1]。 Therefore, some scholars believe that surgical treatment for these patients is of little significance, but some scholars believe that some patients with jaundice have the opportunity to obtain radical resection, and advocate that surgical intervention should not be easily abandoned^[2,3,4,5]。

PatientMale, 66 years old. He was admitted to our hospital on April 24, 2019 due to the discovery that his bile duct occupied 10 days. The patient experienced distension and pain in the right abdomen, fever, and no nausea and vomiting 10 days ago. Ultrasonography at the local hospital revealed intrahepatic bile duct dilatation and cystic mass with hyperechoic mass in the left lobe of the liver. The patient underwent cholecystectomy + partial hepatectomy + biliary enterostomy due to hepatolithiasis more than 10 years ago; Has a history of hypertension and diabetes, and denies a history of biliary ascariasis. Admission physical examination: Old surgical scars were seen in the abdomen, but no abnormalities were found in the rest. Tumor markers: alpha-fetoprotein, carcinoembryonic antigen and CA19-9 were all negative; There were no abnormalities in blood, urine and stool routines; alkaline phosphatase 234 U/L; R-glutamyl transpeptidase 204 U/L. Hepatitis series, syphilis and HIV were all negative. Ultrasound examination: After cholecystectomy, the intrahepatic bile duct was dilated, 0.7 cm in the wider part, and the inner diameter of the anastomosis between the bile duct and the intestinal duct was 1.5 cm. The bile duct in the anastomosis area was dilated, about 2.9 cm in the wider part, and multiple hyperechoic masses were attached inside, showing cauliflower shape, and the larger part was about 4.2 cm ×2.5 cm. Color ultrasound blood flow imaging: in which a strip of blood flow signal can be seen; Contrast-enhanced ultrasound: the mass in the bile duct in the anastomotic area showed high enhancement in the arterial phase, and the overall manifestation of "fast in and slow out". Consideration: Multiple papillomas in the bile duct in the anastomotic area are considered after cholangioenterostomy. Liver enhanced CT + MRI + magnetic resonance cholangiopancreatography showed that the left liver was partially absent after cholecystectomy; Mass-like tissue density shadow in the area of biliary enterostomy, the size of the mass is about 3.8 cm ×2.8 cm, thickened with obvious enhancement; The remaining intrahepatic bile duct was obviously dilated, the wall thickness was associated with nodular changes, and the anastomosis was slightly narrowed; There was no obvious abnormal density shadow in the liver and no obvious filling defect in the portal vein; No obvious enlarged lymph nodes were seen retroperitoneally; The lumen of the pancreatic duct is not narrowed or dilated, and the wall is smooth; The left liver section communicates with the intestinal tube, considering the presence of an internal fistula (FIG. 1A,FIG. 1B,Figure 1C）。 The results of gastroscopy showed that the gastric antrum was obviously congested, and a large amount of mucus was attached near the duodenal bulb, which was difficult to flush off after repeated flushing. Irregular masses under the mucus were vaguely seen, and the surface was congested. Biopsy was given (Figure 1D）。 Histopathological findings: chronic inflammation of mucosa (Figure 2）。