胆肠Roux-en-Y吻合术联合留置皮下空肠盲袢取石治疗肝内胆管结石患者疗效研究*

目的 探讨采用胆肠Roux-en-Y吻合术联合留置皮下空肠盲袢治疗肝内胆管结石(IHS)患者的临床疗效。方法 2018年9月～2021年6月我院诊治的71例IHS患者,其中33例(对照组)接受常规胆肠Roux-en-Y吻合术,另38例(观察组)接受胆肠Roux-en-Y吻合术联合留置皮下空肠盲袢取石治疗。采用ELISA法检测血清C反应蛋白(CRP)和白细胞介素-6(IL-6),使用全自动荧光免疫定量分析仪检测血清降钙素原(PCT)。结果 在术后1个月,观察组临床有效率为94.7%,显著高于对照组的75.8%(P<0.05);观察组血清GGT和ALT水平分别为(71.9±6.2)U/L和(38.7±5.9)U/L,显著低于对照组【分别为(95.8±6.9)U/L和(62.6±6.8)U/L,P<0.05】;观察组血清CRP和IL-6水平分别为(60.8±8.1)mg/L和(89.8±20.1)pg/mL,显著高于对照组【分别为(38.3±9.2)mg/L和(65.7±23.5)pg/mL,P<0.05】;观察组结石残留发生率为7.9%,显著低于对照组的21.2%(P<0.05)。结论 采用胆肠Roux-en-Y吻合术联合留置皮下空肠盲袢取石治疗HIS患者临床疗效较好,可提高结石清除率,防止术后返流性感染,同时也为复发结石、胆管狭窄或梗阻等提供了一条方便的进入肝内胆管的永久性胆道通路,是较为实用的治疗IHS的手术方法。

Short-term efficacy of biliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop in the treatment of patients with intrahepatic bile duct stones

Objective The aim of this study was to investigate the short-term efficacy of biliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop combination in the treatment of patients with intrahepatic bile duct stones (IHS). Methods 71 patients with IHS were enrolled in our hospital between September 2018 and June 2021, and 33 patients in control group were treated by conventional biliary-enteric Roux-en-Y anastomosis, and another 38 patients in observation group were treated with biliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop combination. Serum total bilirubin (TBIL), alkaline phosphatase (ALP), alanine aminotransferase (ALT) and glutamyltransferase (GGT) levels were obtained. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels were detected by ELISA, and serum procalcitonin (PCT) level was assayed by automatic fluorescent immunoquantitative analyzer. Results At the end of one month after surgery, the clinically total effective rate in the observation group was 94.7%, significantly higher than 75.8%(P<0.05) in the control group; serum GGT and ALT levels in the observation groups were (71.9±6.2)U/L and (38.7±5.9)U/L, significantly lower than (95.8±6.9)U/L and (62.6±6.8)U/L, respectively, P<0.05] in the control; serum CRP and IL-6 levels were (60.8±8.1)mg/L and (89.8±20.1)pg/mL, significantly higher than (38.3±9.2)mg/L and (65.7±23.5)pg/mL, respectively, P<0.05] in the control; the postoperative residual of stones in the observation group was significantly less than that in the control group (7.9% vs. 21.2%, P<0.05). Conclusion The combination of iliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop in the treatment of patients with IHS has a good clinical efficacy, which might prevent the postoperative reflux infection and reduce the occurrence of postoperative stone residual, providing a permanent access to the intrahepatic bile duct for recurrent stones.