经开腹胆道旁路术对胆管癌患者胃肠道、胆道功能的影响及手术安全性

Effect of open bile duct bypass on gastrointestinal and biliary function in patients with cholangiocarcinoma and the surgical safety

目的研究经开腹胆道旁路术对胆管癌患者胃肠道、胆道功能的影响及手术安全性。方法选取我院2016年6月至2018年7月收治的160例胆管癌患者为研究对象,根据手术方式的不同将患者分为对照组和观察组,每组80例。对照组患者行传统开腹胆管切除术治疗,观察组患者行开腹胆道旁路手术治疗。比较两组手术后的疼痛程度、胃肠道功能恢复情况、手术前、后的胆道功能、术后并发症发生情况和随访6个月后的复发率。结果观察组患者的疼痛水平明显优于对照组,差异具有统计学意义(P<0.05)。观察组患者的术后排气时间、进食时间均明显短于对照组,差异具有统计学意义(P<0.05);两组患者的肠鸣音恢复及术后排便时间比较,差异无统计学意义(P>0.05)。手术后,两组患者的TBIL水平均降低,且观察组患者的TBIL水平低于对照组(P<0.05)。观察组患者的术后并发症总发生率显著低于对照组(P<0.05);随访6个月后,观察组患者的复发率明显低于对照组(P<0.05)。结论经开腹胆道旁路术治疗胆管癌患者的效果显著,可降低患者的疼痛程度,显著改善患者的胃肠道、胆道恢复情况,并能降低并发症发生率及复发率,值得在临床推广。

Objective To study the effect of open bile duct bypass on gastrointestinal amd biliary function in patients with cholangiocarcinoma and surgical safety. Methods A total of 160 patients with cholangiocarcinoma admitted in our hospital from June 2016 to July 2018 were selected as the study objects. The patients were divided into control group and observation group according to the different operation methods, with 80 cases in each group. Patients in the control group were treated with traditional open bile duct resection, and patients in the observation group were treated with open bile duct bypass operation. The degree of postoperative pain, the recovery of gastrointestinal function, the biliary function before and after surgery, the incidences of postoperative complications and the recurrence rates after 6 months follow-up were compared between the two groups. Results The postoperative pain level of the observation group was significantly better than that of the control group, the difference was statistically significant(P <0.05). The postoperative exhaust time and eating time were significantly shorter than those in the control group, the differences were statistically significant(P<0.05);there were no significant differences in recovery of bowel sounds and defecation time between the two groups(P >0.05).After operation, the levels of TBIL in the two groups decreased, and that in the observation group was lower than the control group(P<0.05). The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P <0.05);the recurrence rate of the observation group after 6 months follow-up was significantly lower than that of the control group(P <0.05). Conclusion The open biliary bypass in patients with cholangiocarcinoma has significant effect, it can reduce the pain degree, significantly improve the gastrointestinal biliary recovery, and reduce the incidence of complications and recurrence of patients, which is worth promoting in clinic.