胆总管十二指肠吻合术治疗胆总管结石远期疗效326例

目的:总结胆总管十二指肠吻合术的远期疗效方法:回顾性分析1962-2002年胆总管十二指肠吻合术326例的临床资料．结果:1982年以前178例,其中36例因吻合口狭窄致胆管炎或胆总管盲端综合征,其中4例死亡,死亡率为2．2％(4／178);1983后强调低位大口径吻合,其中5例出现胆管炎或胆总管盲端综合征,无死亡病例．吻合口径<2．0 cm 85 例,2．0-2．5 cm 153例,2．6-3．0 cm 83例,资料不详5例．经3．-0 a随访278例,随访率为85．3％, 其中1983年以后手术效果的优良率达到 96．6％(143／148)．结论:胆总管十二指肠吻合口径要>2．5 cm, 吻合口位置要低,才可避免逆行性感染和盲端综合征．

Long-term effect of choledochoduodenostomy in treatment of common bile duct stone: an analysis of 326 cases

AIM: To summarize the long-dated curative effect of choledochoduodenostomy in the treatment of common bile duct stone. METHODS: The clinical data of 326 patients received choledochoduodenostomy from 1962 to 2002 were analyzed respectively. RESULTS: Before 1982, there were 178 patients received choledochoduodenostomy, and postoperative cholangitis or blindloop syndrome occurred in 36 cases for anastomotic stricture,4 of which died.The mortality rate was 2.2% (4/178). Since 1983, the low and large-sized anastomotic stoma was emphasized. There were 5 cases with postoperative cholangitis or blindloop syndrome and all of them were cured without complications. The anastomotic stoma of 85 cases was less than 2.0 cm in diameter, 153 cases from 2.0 to 2.5 cm, 83 cases between 2.6 and 3.0 cm, and 5 cases without records. There were totally 278 cases (85.3%) who had been followed up for 3 to 20 years, and the excellent curative rate reached 96.6% (143/148) after the year 1983. CONCLUSION: In order to avoid converse infection and blindloop syndrome, the low anastomotic stoma with a diameter of larger than 2.5 cm is a better choice in choledochoduodenostomy.