中度肝外胆管扩张且Oddi括约肌功能正常的肝胆管结石病的两种术式的疗效对比分析

发布时间：2018-05-12 04:14

本文选题：胆结石 + 肝外胆管切开取石术　；参考：《第三军医大学学报》2017年12期

【摘要】：目的对比肝外胆管切开取石术与胆肠吻合术(Roux-en-Y吻合术)治疗中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病的疗效差异。方法回顾性分析我院2008-2013年收治的188例中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病并行手术治疗的患者病例,96例患者行肝外胆管切开取石术(胆管切开取石术组),92例行胆肠Roux-en-Y吻合术(胆肠吻合术组)。患者均经过3年以上的随访,观察近期疗效(手术并发症)和远期预后(胆管炎、胆管狭窄、结石复发、癌变)情况。结果两组患者术前临床病理特征差异无统计学意义。胆管切开取石术组的手术时间、住院时间优于胆肠吻合术组(P0.05,P0.01);出血量、输血病例数、是否联合肝切除无明显差异。两组术后并发症发生情况差异无统计学意义。术前两组间肝脏生化指标(ALT、AST、GGT、ALP、ALB、TBIL、DBIL)无明显差异,术后胆肠吻合组ALP水平高于肝外胆管切开取石术组(P0.05)。1年后胆管切开取石术组肝功能异常者明显少于胆肠吻合术组(14.6%vs 31.5%,P0.01)。胆管切开取石术组患者胆管积气、反流性胆管炎发作、胆管狭窄发生的比例显著低于胆肠吻合术组(1.0%vs17.4%,4.0%vs 24.0%,3.1%vs 14.1%,P均0.01)。两组间再手术率、结石复发率、癌变率等差异均无统计学意义。结论治疗中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病,肝外胆管切开取石术在胆管积气、反流性胆管炎、胆管狭窄发生率等方面优于Roux-en-Y吻合术。
[Abstract]:Objective to compare the efficacy of extrahepatic cholangiostomy and Roux-en-Y anastomosis in the treatment of moderate extrahepatic bile duct dilatation with normal Oddi sphincter function. Methods A retrospective analysis of 96 patients with moderate extrahepatic bile duct dilatation combined with Oddi sphincter function and surgical treatment was performed in our hospital from 2008 to 2013. Cholangiojejunostomy (Roux-en-Y) was performed in 92 cases of choledojejunostomy group. All patients were followed up for more than 3 years to observe the short-term curative effect (surgical complications) and long-term prognosis (cholangitis, bile duct stenosis, stone recurrence, carcinogenesis). Results there was no significant difference in preoperative clinicopathological features between the two groups. The operative time and hospital stay in the cholangiostomy group was better than that in the choledochojejunostomy group (P 0.05), and there was no significant difference in the amount of blood loss, the number of blood transfusion cases and the combined hepatectomy. There was no significant difference in the incidence of postoperative complications between the two groups. There was no significant difference between the two groups in liver biochemical indexes before operation. The level of ALP in postoperative choledochojejunostomy group was higher than that in extrahepatic cholangiostomy group (P 0.05). After 1 year, hepatic function abnormality in cholangiostomy group was significantly lower than that in cholangioenterostomy group (14.6 vs 31.5). The incidence of bile duct accumulation, reflux cholangitis and biliary stricture in the choledocholithotomy group was significantly lower than that in the cholangiojejunostomy group (1.0 vs 17.4 vs 24.0 vs 24.01 vs 14.1P). There was no significant difference in reoperation rate, stone recurrence rate and canceration rate between the two groups. Conclusion in the treatment of moderate extrahepatic bile duct dilatation with normal Oddi sphincter function hepatobiliary lithiasis, extrahepatic cholangiostomy is superior to Roux-en-Y anastomosis in bile duct gas accumulation, reflux cholangitis and biliary stricture.
【作者单位】：第三军医大学西南医院全军肝胆外科研究所;
【基金】：第三军医大学西南医院临床创新基金课题(SWH2013LC03)~~
【分类号】：R657.42

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