改良胆肠袢式吻合术的疗效分析

Prognostic effect of modified loop choledochojejunostomy

目的探讨改良胆肠袢式吻合术的远期效果。方法回顾性分析2000年1月至2006年12月中山大学附属第一医院收治的259例行胆肠吻合术患者的临床资料。其中行改良胆肠袢式吻合术130例（改良组），行Roux-en-Y吻合术129例（对照组）。比较两组术后胆管炎发生率、肝功能的变化。采用t检验、χ^2检验或Fisher确切概率法对结果进行分析。结果术后改良组ALT、ALP分别为（63±42）U／L、（147±147）U／L，对照组分别为（84±52）U／L、（256±201）U／L，两组比较差异无统计学意义（t=1．634，1．655，P〉0．05）；改良组GGT为（116±91）U／L，低于对照组的（169±96）U／L（t=2．461，P〈0．05）。两组共有12例患者出现不同程度的急性胆管炎，其中改良组有3例（2．3％），对照组有9例（7．0％），改良组少于对照组，但差异无统计学意义（P〉0．05）。发生急性胆管炎的患者中，改良组有1例需住院治疗，对照组有7例，两组比较差异有统计学意义（P〈0．05）。结论改良胆肠袢式吻合术与Roux—en—Y吻合术后急性胆管炎的发生率比较差异无统计学意义，但其术后急性胆管炎的发作频率更低、症状更轻，且操作简单，可作为常规胆肠吻合的方法。

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy （MLC）. Methods The clinical data of 259 patients who had underwent eholedochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC （MLC group） and 129 underwent Roux-en-Y eholedoehojejunostomy （RYC, RYC group）. The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransamiuase and alkaline phosphomonoesterase were （63 ±42）U/L and （147 ± 147）U/L in MLC group, and （84 ± 52）U/L and （256 ± 201 ） U/L in RYC group, with statistical difference between the 2 groups （ t = 1. 634, 1. 655, P 〉0.05 ）. The level of gamma-glutamyl transferase in MLC group was （116 ± 91 ）U/L, which was significantly lower than （169 ± 96）U/L in RYC group （ t = 2. 461, P 〈 0.05）. Three patients （2.3%） in MLC group and 9 （7.0%） in RYC group suffered from acute eholangitis after operation, with no statistical difference in the incidence between the 2 groups （ P 〉 0.05）. Of the 12 patients with acute cholangitis, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups （ P 〈 0.05 ）. Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.