胃肠道转流治疗十二指肠乳头旁憩室致胆管炎的探讨

CHANGING GASTROINTESTINAL ROUTE FOR CHOLANGITIS CAUSED BY DIVERTICULUM BESIDE DUODEUM’S NIPPLE

目的 探讨肠胃道转流治疗十二指肠乳头旁憩室致胆管炎的治疗效果。方法 采用了旷置十二指肠的胃肠道转流术三种术式 34例 ,其中 ,胃空肠 Roux- Y吻合术 12例 ,毕 式胃肠改道术 18例 ,十二指肠空肠吻合术 4例进行外科治疗。结果 三种术式行胃肠道改道的机理相同 ,疗效相近 ,但手术操作及术后并发症各有不同。前两种术式较安全 ,可减少胆胰管损伤及十二指肠瘘的发生 ;操作简便 ,术后并发症少 ,缺点是胃幽门被切除 ,丧失生理能力 ,可引起残胃排空障碍。第三种术式保留了胃和幽门的完整性及其功能 ,可减少胃切除中可能出现的副损伤 ,避免了残胃排空障碍及返流性胃炎等并发症。但因切断十二指肠球部 ,残端较短 ,包埋困难 ,术后有残端瘘之虑。结论 三种术式各有优缺点 。

Objectives To inrestigate the changing Gastrointestinal route for cholangistis caused by diverticulum beside duodeum's nipple.Methods Three methods of operation were used for 34 patients include Rour-Y operation (12 patients),Billroth-Ⅱ method(18 patients) and duodenojejunostomy (4 patients),Rseults The mechanism of three methods is alike,the cureative effect was similar,but the route of operation and complacation after operation was different.Rour-Y and Billroth-Ⅱ method was safety,they can reduce the injury of bile and pancreatic duct,the leak of duodeum's,they were easy to complete in operation,and the complacation was rare after operation.But the disadvantage was the excision of pylorus.Those operation can lead obstrusting of gastric emission.But duodenojejunostomy will reserve pylorus,it can reduce injury of excising pylorus and a part of gastric,avoiding complacation of obstrusting of emission,and returning gastritis.It excised the ball part of duodenum,the remaining of duodenum is short ,containing the remainging is difficult,so it is easy to leak.Conclusion Every method has its advantage and disadvantage.In clinical,we must adopt operation method according the patients condition.