两种不同修补方式治疗胆总管损伤的临床对比研究

Clinical Comparative Study on Two Different Methods of Repair for the Treatment of Common Bile Duct Injury

目的探讨两种不同修补方式治疗胆总管损伤的临床对比情况,从而为治疗胆总管损伤选择最好的治疗方法。方法 36例胆总管损伤病人平分为两组,治疗组患者采用胆总管十二指肠吻合术,对照组患者采用胆总管空肠Rous-en-Y吻合术。结果经过治疗后,治疗组18例患者优8例,良5例,可2例,差3例,优良率为72.2%;对照组18例患者优5例,良9例,可3例,差1例,优良率为77.8%。两组治疗优良率相比无显著性差异(P>0.05)。治疗组的术中出血量、手术时间、肛门排气时间和术后住院时间都明显少于对照组,差异有显著性(P均<0.05)。结论胆囊切除术及胆总管探查术是胆总管损伤的主要原因,胆总管十二指肠吻合术,虽然手术比较简单、安全,但是疗效一直不太好。胆总管空肠Roux-en-Y吻合术可提高治疗效果,但是患者肠道功能恢复较慢,术后恢复时间较长,还需要我们继续研究探讨。

Objective To investigate the clinical comparison of two different ways of repair for the treatment of common bile duct injury,so as to choose the best method for the treatment of bile duct injury. Methods 36 patients with bile duct injury were equally divided into two groups,the treatment group was treated with choledochoduodenostomy,the control group was treated with common bile duct jejunum Rous-en-Y anastomosis. Results After the treatment,in the treatment group 18 patients were excellent in 8 cases,good in 5 cases,fair in 2 cases and poor in 3 cases,the excellent and good rate was 72.2%;in the control group 18 patients were excellent in 5 cases,good in 9 cases,fair in 3 cases and poor in one case,the excellent and good rate was 77.8%. Excellent and good rates of two groups showed no significant difference（P 0.05） . The blood loss,operative time,anal exhaust time and postoperative hospital stay in the treatment group were significantly less than the control group,the difference was significant（all P 0.05） . Conclusion Cholecystectomy and common bile duct exploration are the main reasons of bile duct injury,although the procedure of choledochoduodenostomy is relatively simple,safe,but the efficacy is not very good. Common bile duct jejunum Roux-en-Y anastomosis can improve the therapeutic effect,but the recovery of bowel function in the patients is slow,the postoperative recovery time is longer,so we also need to continue to study.