短袢JICD术与短袢Roux-Y术在治疗肝胆管结石并狭窄中的远期疗效比较

Comparison on Long-term Effects of Short Jejunum Interposed Choledocho-jejunostomy (JICD) and Short Roux-Y in Treatment of Patients with Intra-hepatic Lithiasis Complicated Biliary Stricture

【目的】比较短袢间置空肠胆管十二指肠吻合(JICD)术与短袢Roux-Y术在治疗肝胆管结石并狭窄中的远期疗效及远期并发症的防治。【方法】对131例肝胆管结石并狭窄病例,分别采用短袢JICD术及短袢Roux-Y术两种不同术式进行治疗。随访106例(短袢JICD 42例,短袢Roux-Y 64例,平均7.5年),并观察两组患者的优良率及远期并发症发生率。【结果】短袢JICD组和短袢Roux-Y组平均住院时间分别为(30±8)d和(25±6)d,(P>0.05)。两组优良率分别是95.23%与93.75%(P>0.05),远期并发症中:结石复发、返流性胆管炎的发生率无显著差异(P>0.05)。溃疡病发生率短袢JICD组明显低于短袢Roux-Y组(P<0.05)。【结论】两术式在治疗肝胆管结石并狭窄中均有良好的远期疗效。远期并发症中,溃疡病发生率短袢Roux-Y组明显高于短袢JICD组。

[Objective]To compare long-term effects of short JICD and short Roux-Y on intra-hepatic lithiasis with biliary stricture and long-term complications after surgery. [Methods]One hundred thirty-one patients with intra-hepatic lithiasis with biliary stricture treated in our hospital in the past 20 years were analyzed retrospectively. They were divided into two groups. 42 in short JICD group and 64 in short Roux-Y group,followed up for 7.5 years. The good rates of therapeutic effect and long-term complications after surgery were analyzed. [Results]The average time in hospital stay for short JICD and short Roux-Y were （30±8） days and （25 ±6） days, respectively,their good rates of effect were 95.23% and 93. 75%, respectively. There were no differences between two groups for complication rates of bitiary stone recrudescence and refluent cholangitis, but for prevalence rate of ulcer, short Roux-Y group was higher than short JICD group（ P 〈0.05）. [Conclusion]Both short JICD and short Roux-Y are good for treatment of intra-hepatic lithiasis with biliary stricture, but the former is better than the latter.