胆总管十二指肠吻合和胆管空肠吻合术式选择的临床意义分析—附120例

The Clinical Experience of Surgical Options between Choledochoduodenostomy and Roux-en-Y Cholangiojejunostomy—Report of 120 Cases

目的:探讨胆总管十二指肠侧侧吻合术与胆管空肠Roux-en-Y吻合术的术式选择及远期疗效。方法:总结行胆肠吻合术的120例胆道梗阻病例。原发疾病包括:复发性胆管结石并胆管狭窄65例、先天性胆管囊性扩张症22例、晚期胆道与胰腺肿瘤28例、医源性胆管损伤5例。其中行胆总管十二指肠侧侧吻合术30例(25%),胆管空肠Roux-en-Y吻合术90例(75%)。结果:术后全部病人恢复良好,术后随访98例,随访率81.7%,随访时间为6个月～4年,所有患者术后近期黄疸消退,肝功能恢复,能正常工作生活。远期生存质量评估:胆总管十二指肠吻合术后生存质量优良与良好91.3%(21/23),不良8.7%(2/23);胆管空肠Roux-en-Y吻合术后生存质量优良与良好92.0%(69/75),不良8.0%(6/75)。结论:胆总管十二指肠侧侧吻合术和胆管空肠Roux-en-Y吻合术都能很好起到引流胆汁的效果,严格掌握适应证和精细的手术操作是有效引流、缓解胆道梗阻的保证。

Objective:To explore the surgical options and long-term effect between side-to-side choledochoduodenostomy and Roux-en-Y Cholangiojejunostomy.Methods We concluded 120 cases of bile duct obstruction undergone biliary-enteric anastomosis.The primary disease included 65 cases of recurrent bile duct stones and bile duct stenosis,22 cases of congenital biliary cystic dilatation,28 cases of later period bile duct and pancreatic tumors,and 5 cases of iatrogenic bile duct injury.30 cases of these patients were undergone side-to-side choledochoduodenostomy,and 90 cases undergone Roux-en-Y Cholangiojejunostomy.Result All patients recovered well after surgery.98 cases were followed up,and the follow-up rate was 81.7%.The follow-up time was 6 months to 4 years.They survived with extinctive jaundice,better liver function and normal work and life.Long-term quality of life assessment:91.3%(21/23) of patients undergone choledochoduodenostomy were excellent and good and 8.7%(2/23) was negative;92.0%(69/75) of patients undergone Roux-en-Y Cholangiojejunostomy were excellent and good and 8.0%(6/75) was negative.Conclusion Both side-to-side choledochoduodenostomy and Roux-en-Y cholangiojejunostomy could play an important role in drainage of bile.To know well of the indications and fine surgical operation is the guarantee of effective drainage and remission of biliary obstruction.