不同胆肠吻合术式与远期疗效比较分析

Comparative analysis of different operative methods of cholangio-enterostomy and long-term results

目的 探讨对胆道良性疾病行不同胆肠吻合术式的远期疗效。方法 对 1982年 1月至 2 0 0 1年 12月 ,行胆肠吻合术的胆道良性疾病 614例进行总结分析。结果 术后随访 5 2 4例 ,随访率为 87.9% ;随访时间为1～ 2 0年。效果优、良者占 84.5 %。总的再手术率 13 .7% ( 72 / 5 2 4) ,胆管 (或囊肿 )十二指肠吻合组 49.4% ,胆管(或囊肿 )空肠侧 -侧吻合组为 14 .2 % ,胆管空肠端 -侧吻合组为 4.4% ,三组间再手术率差异有显著性 (P <0 .0 1或P <0 .0 5 )。结论 肝内、外胆道良性疾病行胆肠吻合术时 ,胆管 (或囊肿 )十二指肠吻合术式应废除 ,胆管空肠 (Roux -en -Y)端 -侧吻合术式应作为首选 。

Objective\ To investigate the cholangio-enterostomy type and the long-term results in treatment of benign diseases of biliary tract.Methods To follow up and analyze a total of 614 cases of cholangio-enterostomy from Janury 1982 to December 2001.Results\ Five hundred and twenty-four cases had been followed up for 1 to 20 years,the rate of follow-up was 87.9%.In 84.5% of the cases,excellent or good long-term results were achieved.The total re-operation rate was 13.7%(72/524).Re-operation rate was 49.4% in cases of choledochoduodenostomy or cystoduodenostomy,14.2% in side-to-side(cysto)cholangio-jejunostomy and 4.4% in end-to-side cholangiojejunostomy respectively(P<0.01 or P<0.05).Conclusion\ The choledochoduodenstomy or cystoduodenostomy should be abolished.The end-to-side cholangiojejunostomy (Roux-en-Y) shoud be the first choice when it is needed to perform cholangiojejunostomy in benign bile duct diseases and can promise a satisfactory long-term result.