胆肠改良襻式吻合术与Roux-en-Y吻合术的临床对比分析

Comparition of clinical efficacy between modified uncut jejunal loop anastomosis and Roux-en-Y choledochojejunostomy

目的比较胆肠改良襻式吻合术与Roux-en-Y吻合术的疗效。方法收集139例行胆肠改良襻式吻合术及120例行胆管空肠Roux-en-Y吻合术胆道重建患者的临床资料,比较其手术时间、术中出血量、肠道功能恢复时间及出院时间,并观察2组间术后并发症的差异。结果与胆管空肠Roux-en-Y吻合术组比较,胆肠改良襻式吻合术组的手术时间更短,患者术中出血更少、肛门排气时间及住院时间均更短(P均<0.05)。术后出现胆汁漏在胆肠改良襻式吻合术组为4例(2.9%),低于Roux-en-Y吻合术组的13例(10.8%),P<0.01。术后2组患者的急性胆管炎和胃排空障碍发生率比较差异均无统计学意义(P均>0.05)。结论胆肠改良襻式吻合术更符合生理,术后恢复较快,发生胆汁漏出风险较低,优于胆管空肠Roux-en-Y吻合术。

Objective To compare the clinical efficacy between modified uncut jejunal loop anasto-mosis and Roux-en-Y choledochojejunostomy. Methods Clinical data of 139 patients undergoing modified uncut jejunal loop anastomosis and 120 receiving Roux-en-Y choledochojejunostomy were retrospectively analyzed. The operation time, intraoperative hemorrhage volume, the time of intestinal function recovery, discharge time and postoperative complications were statistically compared between two groups. Results Compared with patients undergoing Roux-en-Y choledochojejunostomy, intraoperative hemorrhage was significantly reduced and the operation time, time of first flatus and length of hospital stay were significantly shortened in the modified uncut jejunal loop anastomosis group （all P 〈0. 05）. In the modified uncut jejunal loop anastomosis group, the incidence of bile leakage was 2. 9% （n =4） , significantly lower compared with 10. 8% （n = 13） in the Roux- en-Y choledochojejunostomy group （P〈0. 01）. The incidence of acute cholangitis and delayed gastric emptying did not significantly differ between two groups （ both P 〉 0. 05 ）. Conclusion Compared with Roux-en-Y choledochojejunostomy, the modified uncut jejunal loop anastomosis yields better physiological status, faster postoperative recovery and lower incidence of cholangitis.