不同胆道重建方式治疗先天性胆管扩张症的疗效对比研究

目的比较肝管空肠Roux-Y吻合术、改良肝管空肠Roux-Y吻合术、肝管空肠Roux-Y吻合术+矩形瓣术3种胆道重建方式治疗先天性胆管扩张症的临床效果。 方法选择恩施土家族苗族自治州中心医院2010年10月至2013年7月收治的90例先天性胆管扩张症患者，随机分为A组（行肝管空肠Roux-Y吻合术）、B组（行改良肝管空肠Roux-Y吻合术）和C组（采取肝管空肠Roux-Y吻合术+矩形瓣术），各30例。比较3组治疗总有效率、抗反流效果、手术时间、出血量、住院时间、近期并发症发生率，术后长期随访，评价3组患者的远期疗效及并发症总发生率。 结果B组与C组的治疗总有效率分别为93.3%和96.7%，优于A组的73.3%，差异有统计学意义（Z=10.881，P<0.01）。B组与C组反流性胆管炎分别为13.3%和10.0%，低于A组的36.7%，差异有统计学意义（χ²=7.917，P=0.019）。3组手术时间、出血量、住院时间的差异无统计学意义（F=0.795、2.217、2.919，P=0.454、0.115、0.059）。A、B、C组的近期并发症分别为26.7%（8/30）、20.0%（6/30）和13.3%（4/30），差异无统计学意义（χ²=1.667，P=0.435）。随访时间1.5~4年，平均（2.8±1.2）年，C组远期并发症总发生率为13.3%（4/30），显著低于A组的43.3%（13/30）、B组的40.0%（12/30），差异有统计学意义（χ²=7.428，P=0.024）。 结论肝管空肠Roux-Y吻合术+矩形瓣术治疗先天性胆管扩张症具有良好抗反流作用且远期并发症少，效果理想。

Comparative study of the therapeutic effect of different biliary tract reconstruction methods in the treatment of congenital cholangiectasis

ObjectiveTo compare the clinical effect of three kinds of biliary reconstruction methods for congenital bile duct dilatation: hepatic duct jejunum Roux-Y anastomosis, modified hepatic duct jejunum Roux-Y anastomosis, and hepatic duct jejunum Roux-Y anastomosis+rectangle flap operation. MethodsFrom October 2010 to July 2013, ninety patients with congenital biliary dilatation in the Central Hospital of Enshi Autonomous Prefecture were selected and randomly divided into group A (hepatic jejunum Roux-Y anastomosis), group B (modified hepatic jejunum Roux-Y anastomosis) and group C (hepatic jejunum Roux-Y anastomosis+ rectangular flap surgery), with 30 cases in each group. The total effective rate, anti-reflux effect, operation time, blood loss, hospitalization time, the incidence of recent complications and the total incidence of long-term complications were compared between the three groups after long-term follow-up. ResultsThe total effective rates of group B and group C were 93.3% and 96.7%, which were higher than 73.3% in group A, the difference was statistically significant (Z=10.881, P<0.01). The incidence of reflux cholangitis in group B and group C were 13.3% and 10.0%, lower than 36.7% in group A (χ²=7.917, P=0.019). There were no significant differences in operation time, blood loss and hospitalization time among the three groups (F=0.795, 2.217, 2.919, P=0.454, 0.115, 0.059). The incidence of recent complications in group A, B, C were 26.7%, 20.0% and 13.3% respectively, with no statistically significant difference (χ²=1.667, P=0.435). After 1.5-4 (2.8±1.2) years of follow-up, the total incidence of long-term complications in group C was 13.3% (4/30), which was lower than that in group A (43.3%, 13/30) and group B (40.0%, 12/30), the difference was statistically significant (χ²=7.428, P=0.024). ConclusionThe application of Roux-Y anastomosis and rectangular flap surgery in hepatic duct jejunum in congenital biliary dilatation has good anti-reflux effect and less long-term complications, and the effect is ideal.