胆管空肠十二指肠X—Y分流术的研究

STUDY ON CHOLANGIO JEJUNOSTOMY WITH X-Y PATTERN DUODENAL DIVERSION

采用改良的胆肠内引流术式,即在端侧侧盲袢胆空Roux—en—Y吻合术基础上,附加一胆肠支空肠与十二指肠降段的侧侧吻合。经对照的动物实验后临床运用,术后胆管内不存在高压状态,胆汁引流通畅,可避免肠胆返流,胆汁与食物接触时间接近正常。病人术后胃酸分泌量不增高。术后随访3月～3年,优良率95.53％。

A lateral anastomosis of the descending portion of the duodenum (X-Y pattern) in addition to the traditional Rour-en-Y cholangiojejunostomy in treatment of primary bile duct stones is reported. Controlled study on 19 small pig models revealed that: the intradefunctionalized j-loop pressure was decreased, a free flow of bile into the duodenum was thus possible tq prevent postoperative gastric acid hypersecretion, and diversion of the duodenal content into the distal defunctionalized j-loop would prevent entero-biliary reflux. (P < 0.05) Thirty patients suffering from primary bile duct stone were performed on this operation. Postoperative gastric acid secretion didn't increase (P>0.05) . Intraductal pressure remained in the normal range of 1530±470 Pa. Barium meal X-ray examinations did not demonstrate any reflux into the biliary tract, and trans-T tube cholangiograms showed a rapid diversion of a large amount of the contrast into the duodenum. After follow-up of 3-36 months, 96% of the patients was in good condition. This new operation is more com-patible with digestive physiology and recommendable in clinical practice.