胆肠Roux-en-Y吻合术留置皮下空肠盲袢治疗肝内胆管结石患者效果分析*

目的 探讨采用胆肠Roux-en-Y吻合术留置皮下空肠盲袢治疗肝内胆管结石患者的效果。方法 2017年9月～2020年9月我院收治的74例肝内胆管结石患者,随机分为对照组37例和观察组37例,分别采用胆肠Roux-en-Y吻合术或胆肠Roux-en-Y吻合术留置皮下空肠盲袢治疗,分别采取不同的方法再次取石。采用ELISA法检测血清白介素-6(IL-6)和肿瘤坏死因子(TNF-α)。结果 观察组手术时间为(265.4±27.1)min,显著长于对照组【(243.5±25.6)min,P＜0.05】;术后,两组血清总胆红素、谷氨酸氨基转移酶和γ-谷胺酰转肽酶水平均显著下降,但两组间无显著性差异(P>0.05);两组白细胞计数、血清IL-6和TNF-α水平均显著下降,但两组间无显著性差异(P>0.05);经随访发现,在本组74例患者中有14例再次进行了取石治疗,其中观察组3例(8.1%),对照组11例(29.7%,P＜0.05)。结论 采取胆肠Roux-en-Y吻合术并留置皮下空肠盲袢治疗肝内胆管结石患者有助于再次取石,值得临床研究。

Indwelling subcutaneous jejunal blind loop and Roux-en-Y choledochojejunostomy in treatment of patients with hepatolithiasis

Objective The aim of this study was to investigate the efficacy of indwelling subcutaneous jejunal blind loop and Roux-en-Y choledochojejunostomy in treatment of patients with hepatolithiasis. Methods 74 patients with hepatolithiasis were admitted to our hospital between September 2017 and September 2020, andwere randomly divided into control and observation group, with 37 cases in each, receiving Roux-en-Y choledochojejunostomy or Roux-en-Y choledochojejunostomy and indwelling subcutaneous jejunal blind loop thereafter. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results The operation time in the observation group was (265.4±27.1) min, significantly longer than (243.5±25.6) min, P<0.05] in the control group; after the operation, total serum bilirubin, alanine aminotransferase and gamma-glutamyltransferase levels in the two groups decreased greatly, and no significant differences among them between the two groups (P>0.05); the white blood cell counts, serum IL-6 and TNF-α levels decreased greatly, and no significant differences among them between the two groups (P>0.05); during the follow-up periods, 14 patients out of our series had second or more time operations to remove the stones, of which 3 cases(8.1%) from the observation and 11 cases (29.7%, P＜0.05) from the control. Conclusion The procedure of indwelling subcutaneous jejunal blind loop after Roux-en-Y choledochojejunostomy is beneficial to repeated removing stones from intrahepatic bile ducts, which warrants further investigation.