胆肠吻合在肝内外胆管结石治疗中的应用价值分析

Value of choledochoenterostomy in the treatment of hepatolithiasis and/or extrahepatic cholangiolithiasis

目的分析胆管空肠肠Roueny吻合手术在肝内外胆管结石治疗中的应用价值。方法对2004年1月至2013年12月间我院收治的胆肠吻合的患者进行回顾性分析,未获得随访的患者列为排除标准。结果 10年间因肝内外胆管结石行胆肠吻合术且获得有效随访的患者96例,结石复发13例,再次手术8例,未复发结石者反复发生胆管炎8例。胆总管直径大于2.5 cm和小于2.5 cm者的复发比例分别为3.3%（1/30）和18.2%（12/66）,差异有统计学意义（χ~2=3.884,P=0.049）;Oddi括约肌松弛者的复发率为3.0%（1/33）,无松弛者的复发率为18.8%（12/64）,差异有统计学意义（χ~2=4.449,P=0.025）;手术方法采用胆总管断端与空肠端侧吻合者术后复发率8.1%（6/74）低于胆总管与空肠侧侧吻合者31.8%（7/22）,差异有统计学意义（χ~2=8.143,P=0.004）;行胆肠吻合前的手术次数、胆总管下端是否狭窄以及黄疸情况对术后结石复发均无统计学意义（P〉0.05）。结论对于肝内外胆管结石患者,在必须保证上游狭窄解除,指征明确时行胆肠吻合术才可以最大限度降低术后结石复发几率,胆总管与空肠的端侧吻合为相对较合理的吻合方式。

Objective To analyze the clinical value of Rou-en-y choledochoenterostomy in the treatment of hepatohthiasis and/or extrahepatic cholangiolithiasis. Methods A retrospective analysis of the 96 patients admitted into our hospital from January, 2004 to December, 2013 for the treatment of choledochoenterostomy was made. Those who failed to have medical follow-up were exclu- ded in the study. Results In the said 10 years, there were 96 patients who underwent choledochoenterostomy due to hepatolithiasis and/or extrahepatic cholangiolithiasis and had due medical follow-ups. Of the 96 cases, 13 cases had bile duct stone recurrence, 8 had re-surgery treatment and another 8 had recurrent cholangitis. The recurrent rates for those patients with the internal diameter of hepato- cystic duct larger or smaller than 2.5cm were respectively 3.3% （1/30） and 18.2% （12/66）. There were significant differences in them, when comparisons were made between the 2 （ x2= 3. 884, P = 0. 049）. The recurrent rate of Oddi sphincter relaxation was 3.0% （ 1/33 ）, the recurrent rate of no Oddi sphincter relaxation was 18.8% （12/64）. There was statistical significance, when comparisons were made between the 2 （ X2 = 4. 449, P = 0.025 ）. The recurrent rate in cases of the end-to-side cholangiojejunostomy was 8.1 （ 6/ 74）, which was lower than that of the side-to-side eholangiojejunostomy [ （31.8% （7/22） ], （X2 = 8. 143, P = 0. 004）. Before the implementation of choledochoenterostomy, the number of surgery, the stricture of the lower end hepatocystic duct and jaundice had no significant effect on the recurrence of biliary calculi. Conclusion For the patients with hepatolithiasis and/or extrahepatic cholangiolith- iasis, it was ascertained that the upstream stricture be released. When the indication of the Rou-en-y choledochoenterostomy was clear, choledochoenterostomy should be performed, so as to reduce the recurrent rate of biliary calculi to the largest extent. The end-to-side cholangiojejunostomy was considered as the relatively reasonable anastomosis.