改良胆肠Roux-en-Y吻合术在治疗恶性梗阻性黄疸中的应用

Improved Roux-en-Y Cholangiojejunostomy in the Treatment of Malignant Obstructive Jaundice

目的探讨改良Roux-en-Y胆肠吻合术治疗胆道恶性梗阻的效果及临床应用价值。方法回顾性分析36例胆道恶性梗阻需行胆肠吻合术患者的临床资料,其中行改良Roux-en-Y胆肠吻合术21例(改良组),同期行经典Roux-en-Y胆肠吻合术15例(经典组)。改良Roux-en-Y胆肠吻合术在传统袢式吻合的基础上作了两项改进:①不切断空肠,输入袢和输出袢之间行侧侧吻合;②近段输入袢空肠结扎,阻断肠内容物进入肠道。观察两组手术时间、肠功能恢复时间、住院时间、返流性胆管炎减黄疗效及并发症发生情况。结果改良组术中胆肠吻合时间、术后住院时间及肠功能恢复时间明显缩短,返流性胆管炎发生率显著减少,差异有统计学意义(P<0.05),两组术后减黄效果均明显,但组间比较无明显差异(P>0.05)。结论改良Roux-en-Y胆肠吻合术操作简单、术后恢复快,尤其适用于高龄无法行根治性手术的恶性胆道肿瘤患者,值得临床推广应用。

Objective To explore the effectiveness and the value of clinical applications the improved Roux-en-Y cholangiojejunostomy in treating malignant obstructive jaundice.Methods A retrospective study was applied in 36 cases of biliopancreatic obstruction,in whom 21 cases underwent the improved Roux-en-Y cholangiojejunostomy,and 15 cases underwent the classic Roux-en-Y cholangiojejunostomy.The modified Roux-en-Y biliary-enteric anastomosis made two improvements based on the traditional one： ①Side to side anastomosis between the input and output loops with out jejunectomy;②Proximal jejunal loop ligation to block the entrance of the intestinal contents.Result The operation time,the bowel function recovery time and the hospitalization time were significantly reduced in the improved Roux-en-Y cholangiojejunostomy group（P〈0.05）.Conclusion It is recommended of the improved Roux-en-Y cholangiojejunostomy of the advantages of simple operation and quick postoperative recover,which may be especially suitable for the elderly.