胆总管十二指肠吻合术治疗良性胆道梗阻的远期疗效观察

The Long-term Effect of Choledochoduodenostomy for Benign Biliary Tract Obstruction

为了探讨胆总管十二指肠吻合术的疗效，对随访时间１０年以上，应用胆总管十二指肠吻合术（ＣＤＤ）治疗胆道良性梗阻的４６例随访结果进行了分析。结果显示：疗效优２６例（５６．５％），良１３例（２８．３％），差７例（１５．２％）。优良率８４．８％，与同期胆总管空肠Ｒｏｕｘ－ｅｎ－ｙ吻合１７１例的优良率８６．５％相比，无显著差异（Ｐ＞０．０５）。提示：对于胆道良性梗阻，特别是高危老年病人，ＣＤＤ仍是一种安全有效的术式；胆总管扩张达１．５ｃｍ以上，吻合口达２．５ｃｍ以上，吻合口上方各级胆道无残留病变是取得远期良好效果的基本条件。

This article analyses the long-term follow-up results observed in 46 cases who underwent choledochoduodenostomy (CDD) with benign biliary tract obstruction. Follow-up time of all cases was more than 10 years. The results of treatment were as follows: excellent in 26 (56.5%) cases, good in 13 (28.3%) and poor in 7 (15.2%), excellentgood rate 84.8% which was not significantly different compared with the results in 171 cases which underwent Rouxeny choledochojejunostomy (excellentgood rate 86.5%) simultaneously (P>0.05). In authors opinion, CDD is a relatively safe, definitive procedure for treatment of benign biliary obstruction, with good long-term results in high-risk, aged patients. The presence of a dilated common bile duct (more than 1.5cm) that allows the construction of a diameter of CDD more than 2.5cm and no remaining problem above the anastomosis are essential to obtain good results.