本文選題：膽結(jié)石 + 肝外膽管切開取石術(shù)�。� 參考：《第三軍醫(yī)大學(xué)學(xué)報》2017年12期

【摘要】：目的對比肝外膽管切開取石術(shù)與膽腸吻合術(shù)(Roux-en-Y吻合術(shù))治療中度肝外膽管擴(kuò)張合并Oddi括約肌功能正常的肝膽管結(jié)石病的療效差異。方法回顧性分析我院2008-2013年收治的188例中度肝外膽管擴(kuò)張合并Oddi括約肌功能正常的肝膽管結(jié)石病并行手術(shù)治療的患者病例,96例患者行肝外膽管切開取石術(shù)(膽管切開取石術(shù)組),92例行膽腸Roux-en-Y吻合術(shù)(膽腸吻合術(shù)組)�；颊呔�(jīng)過3年以上的隨訪,觀察近期療效(手術(shù)并發(fā)癥)和遠(yuǎn)期預(yù)后(膽管炎、膽管狹窄、結(jié)石復(fù)發(fā)、癌變)情況。結(jié)果兩組患者術(shù)前臨床病理特征差異無統(tǒng)計學(xué)意義。膽管切開取石術(shù)組的手術(shù)時間、住院時間優(yōu)于膽腸吻合術(shù)組(P0.05,P0.01);出血量、輸血病例數(shù)、是否聯(lián)合肝切除無明顯差異。兩組術(shù)后并發(fā)癥發(fā)生情況差異無統(tǒng)計學(xué)意義。術(shù)前兩組間肝臟生化指標(biāo)(ALT、AST、GGT、ALP、ALB、TBIL、DBIL)無明顯差異,術(shù)后膽腸吻合組ALP水平高于肝外膽管切開取石術(shù)組(P0.05)。1年后膽管切開取石術(shù)組肝功能異常者明顯少于膽腸吻合術(shù)組(14.6%vs 31.5%,P0.01)。膽管切開取石術(shù)組患者膽管積氣、反流性膽管炎發(fā)作、膽管狹窄發(fā)生的比例顯著低于膽腸吻合術(shù)組(1.0%vs17.4%,4.0%vs 24.0%,3.1%vs 14.1%,P均0.01)。兩組間再手術(shù)率、結(jié)石復(fù)發(fā)率、癌變率等差異均無統(tǒng)計學(xué)意義。結(jié)論治療中度肝外膽管擴(kuò)張合并Oddi括約肌功能正常的肝膽管結(jié)石病,肝外膽管切開取石術(shù)在膽管積氣、反流性膽管炎、膽管狹窄發(fā)生率等方面優(yōu)于Roux-en-Y吻合術(shù)。
[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.
【作者單位】： 第三軍醫(yī)大學(xué)西南醫(yī)院全軍肝膽外科研究所;
【基金】：第三軍醫(yī)大學(xué)西南醫(yī)院臨床創(chuàng)新基金課題(SWH2013LC03)~~
【分類號】：R657.42

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