改良胆肠襻式吻合术在胆肠疾病中的应用

Modified Loop-Type Biliary-Enteric Anastomosis for Biliary-Enteric Diseases

目的:探讨改良胆肠襻式吻合术在胆肠疾病中的应用及其优点。方法:回顾分析31例胆肠吻合术患者的临床资料,其中15例行改良胆肠襻式吻合术(改良组),16例行胆肠Roux-en-Y吻合术(对照组),比较两组手术时间、术中出血量,术后胆管炎的发生率、肝功能状况、胆汁返流程度。结果:改良组手术时间[(1.0±0.5)h]较对照组[(1.5±0.8)h]明显缩短(P<0.01),术中出血[(110±65)ml]也较对照组[(150±70)ml]少(P<0.01);术后1周肝功能状况:改良组ALT(72±40)U/L,AST(110±85)U/L,对照组ALT(92±60)U/L,AST(150±86)U/L,提示改良组术后肝功能明显好于对照组(P<0.01)。术后钡剂灌肠了解胆汁返流程度,发现改良组轻度返流者4例,重度返流1例;对照组轻度返流8例,重度返流3例,改良组术后胆汁返流程度明显好于对照组(P<0.01)。两组共有5例急性胆管炎发生,改良组1例,对照组4例。结论:改良胆肠袢式吻合术较传统胆肠Roux-en-Y吻合术,能缩短手术时间、减少手术出血量、改善术后肝功能、术后胆汁返流发生率低、手术操作简单方便等优点,值得在胆肠疾病治疗中进一步推广应用。

Objective： To evaluate the efficacy of modified choledochojejunostomy （MC） in bilary-enteric diseases. Methods： Thirty-one patients who had undergone choledochojejunostomy from January 2005 to December 2009 were retrospectively analyzed. Of all the patients, 15 underwent modified choledochejejunotstomy （MC group） and 16 underwent Roux-en-Y choledojejurowomy （R-Y group）. The time of operation, blood loss during operation, incidence of cholangitis, liver function, and bile reflux were compared between the two groups. Results： The time of operation was （1.0±0.5） h in MC group and （1.5±0.8） h in R-Y group respectively （P0.01）. Blood loss was （110±65） ml in MC group and （150±70） ml in R-Y group respectively （P0.01）. The levels of alanine aminotransferase and aspartate aminortransferase were （72±40） U/L and （110±85）U/L in MC group, and （90±60） U/L and （150±56） U/L in R-Y group respectively （P0.01）. There were 6 cases of slight regurgitation and 1 case of severe regurgitation in the MC group, while 9 cases of slight regurgitation and 2 cases of severe regurgitation in the R-Y group. One patient in MC group and 3 patients in R-Y group suffered from acute cholangitis after operation. Conclusion： Compared with Roux-en-Y choledochojejunostomy, MC is much easier, more practical and feasible, with less blood loss, and could be applied in the treatment of biliary-enteric diseases.