横行肠肠吻合并行同步法在胆肠吻合术中抗反流效果的临床分析

The clinical antireflux analysis on transverse anastomosis and side by side serosa suturing between jejunum in choledochojejunostomy

目的探讨在胆肠吻合术中加用抗反流术对防止反流性胆管炎的作用。方法对2002年9月至2008年12月间行胆肠吻合手术的40例患者,按发病时间顺序将其分为两组,传统手术组20例和改良手术组20例,前组采用经典的胆肠Roux-en-Y吻合术;后组采用胆肠Roux-en-Y吻合术,并加用抗反流术,包括近端空肠与远端空肠行横口吻合,近端空肠与旷置袢并行同步浆肌层缝合（5 cm）,观察术后随访反流性胆管炎临床症状及胃肠钡餐造影情况。结果术后效果随访40例,随访时间为2~8年,随访率为100%。改良组随访优良率达68.8%,无严重并发症及胆管炎发生,明显优于传统组的33.3%（P〈0.01）。结论在行胆肠内引流术中加用抗反流术可有效地防止反流性胆管炎。

Objective To explore the effect of choledochojejunostomy plus antireflux operation on preventing reflux cholangitis.Methods The clinical data of the patients with choledochojijunostomy treatment in our hospital from September 2002 to December 2008 were retrospective analyzed 40 cases of PGS were randomly divided into 2 groups accolding to time.Group 1（n=20） were performed by classic choledochojejunostomy;while group 2（n=20） were performed by combination operation,the latter including Roux-en-Y tipe choledochojejunostomy plus antireflux operation including end-to-side transverse anastomosis between proximal and distal jejunum and side by side serosa suturing（5cm） between proximal jejunal and interposed jejunal loop.The clinical symptom of postoperative reflux cholangitis and gastroenterography were investigated and compared between the two groups.Results A total 40 cases were followed up for 2 to 8 years,the rate of follow-up was 100%.Excellent and good results were achieved in 68.8% of the postoperative patients without severe complications and reflux cholangitis in the group 2,which was significantly higher than that in the group 1 which was 33.3%（P0.01）.Conclusion It is effective to use using choledochojejunostomy plus antireflux operation to prexrent reflux cholangitis.