闭合空肠输入段改良胆肠Roux-en-Y吻合术的临床研究

目的：探讨闭合空肠输入段改良胆肠Roux-en-Y吻合术的临床效果。方法：我科2009年1月—2011年9月行胆肠吻合术80例,其中胆管空肠Roux-en-Y吻合术组（传统胆肠吻合术组）38例,闭合空肠输入段胆管空肠Roux-en-Y吻合术组（改良胆肠吻合术组）42例,比较两组术中完成胆肠吻合的时间、术后肠道功能恢复时间、术后第3天胆红素水平及术后3月上消化道造影检查等方面指标。结果：改良胆肠吻合术组完成胆肠吻合时间40.2±9.3 min,较传统胆肠吻合术组完成胆吻合时间60.2±6.2min明显缩短,差异有统计学意义（P〈0.05）;两组肠功能恢复时间、术后3个月上消化道造影胆汁反流率比较,差异均具有统计学意义（P〈0.05）。术后第3天胆红素水平比较两组差异无统计学意义（P〉0.05）。术后随访79例,失访1例,随访率为98.7%,随访时间为3个月～2.5年,随访患者中3例术后出现右上腹部不适、轻度胀痛等症状,余无异常。结论：改良胆肠Roux-en-Y吻合术手术操作简单,胆肠吻合时间短,胆汁反流发生率低,术后疗效确切,具有一定临床应用价值,尤其适合基层医院开展。

Clinical research of choledochojejunostomy with jejunum input closed

Objective:To evaluate the clinical effects of improved Roux-en-Y cholangioenterostomy with the jejunum input.closed.Method:38 cases of traditional roux-en-y choledochojejunostomy and 42 cases of improved choledochojejunostomy using linear stapler(By Beijing gold Shelley medical Co.,LTD.Offers Model 30 H) were analyzed retrospectively from January 2009 to September 2011.Compared clinnical effects of the 2 groups including intraoperative time,index of bilirubin,postoperative.recovery of the bowel peristalsis,bile reverse flow by upper gastrointestinal radiography.Results:Time cost of improved choledochojejunostomy is 45.2±9.3 min,obviously reduced comparing to 60.2±6.2 min of the traditional procedure 1 case lost in follow-up,the rest ware followed-up from 3 months to 2.5 years.3 cases suffered upper right abdominal discomfort,mild pain and other symptoms.Conclusions:Operation of improved choledochojejunostomy is simple,time cost is reduced,Bile reflux rate is relatively low.This procedure has certain clinical application value,especially suitable for patients in primary hospital.