改良胆肠襻式吻合与Roux-en-Y吻合治疗胆道梗阻的临床对比研究

Improvement of bile loops of bowel anastomosis and Rouxen-Y anastomosis in two types of operation for treatment of biliary obstruction clinical comparative study

目的:比较胆道梗阻性疾病胆肠吻合应用改良胆肠襻式吻合术式和Roux-en-Y吻合术式的临床疗效。方法:回顾性分析72例行胆肠吻合术患者的临床资料,其中行改良胆肠襻式吻合36例(改良组),行胆肠Roux-en-Y吻合术36例(对照组)。比较两组患者吻合手术时间、肠鸣音出现、肛门排气及住院时间,观察胆汁漏发生、总胆红素下降指标、胆肠吻合口狭窄、胆汁反流情况。结果:改良组吻合手术时间较对照组明显缩短(0.9±0.4 h vs 1.4±0.6 h,P<0.05);术后肠鸣音出现时间较对照组早(2.3±4.0h vs 60.2±5.2 h,P<0.05),肛门排气时间较对照组提前(70.2±5.3 h vs 88.1±6.5 h,P<0.05),住院时间较对照组少(10.0±1.9 d vs 12.0±3.0 d,P<0.05)。术后对照组发生1例胆汁漏(5.6%);术后2周总胆红素下降指标>50%比率,改良组优于对照组(91.7%vs 83.3%);胆肠吻合口狭窄情况改良组优于对照组(2.8%vs 5.6%);术后胆汁反流情况改良组优于对照组(2.8%vs 8.3%)。结论:改良胆肠襻式吻合术较传统胆肠Roux-en-Y吻合术,能缩短手术时间、肠道功能恢复快、改善术后肝功能,术后胆汁反流发生率低、手术操作简单方便,尤其适用于基层县级医院,但仍存在捆扎肠襻再通可能,需进一步改进。

Objective： Study of biliary obstructive diseases in patients with biliary enteric anas- tomosis using modified biliary intestinal loop type anastomosis and Roux-en-Y anastomosis clinicalcurative effect comparison. Methods： A retrospective analysis of 72 cases of biliary enteric anasto- mosis in patients with clinical data, two groups of data bank improved bile loops of bowel anastomo- sis in 36 cases （improved group）, Roux-en-Y line of bilioenteric anastomosis in 36 patients（control group）.Comparison of two groups of patients with operation time,gurgling sound appears,anal ex- haust and hospitalization time,and the observation of bile leak occurred,total bilirubin decreased in- dex,biliary enteric anastomosis stricture,bile reflux. Results： The improved group at the anasto- mosis operation time required for [（0.9± 0.4） h] than the control group [（1.4± 0.6） hi was signifi- cantly shortened （P〈0.05）, postoperative bowel sounds appear time [ （ 52.3 ± 4） h] than the control group [ （60.2± 5.2） hi less （P〈0.05）, anal exhaust time （70.2 ± 5.3） hi than the control group [ （88.1 ± 6.5） h] （P〈0.05）, less hospital stay [ （10.0 ±1.9） d] compared with the control group I （12 ± 3） d] （P〈0.05）; less postoperative bile leaks： improved group, the control group took place in 1 cases （5.6%）, after 2 weeks of total bilirubin decreased index 〉50%： improvement of group of 33 patients （91.7%） than the control group of 30 cases（83.3%）; bilioenteric anastomotic stenosis： improvement of group of 1 patients （2.8%） than the control group of 2 cases （5.6%）; postoperative bile reflux： improvement of group of 1 patients （2.8%） than in control group of 3 patients （8.3%）. Conelu, sion： Improvement of bile loops of bowel anastomosis biliary enteric anastomosis than traditional Roux-en-Y, can shorten the operation time, recovery of intestinal tract function quickly, improve postoperative liver function, postoperative bile reflux incidence is low, the operation is simple and convenient wait for an advantage, be in patients with biliary obstruction in the treatment of further popularization and Application, especially suitable for the basic level hospitals, but there are still bind- ing loops of bowel reperfusion may, and further research is needed to improve.