中度肝外胆管扩张且Oddi括约肌功能正常的肝胆管结石病的两种术式的疗效对比分析

目的 对比肝外胆管切开取石术与胆肠吻合术(Roux-en-Y吻合术)治疗中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病的疗效差异.方法 回顾性分析我院2008-2013年收治的188例中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病并行手术治疗的患者病例,96例患者行肝外胆管切开取石术(胆管切开取石术组),92例行胆肠Roux-en-Y吻合术(胆肠吻合术组).患者均经过3年以上的随访,观察近期疗效(手术并发症)和远期预后(胆管炎、胆管狭窄、结石复发、癌变)情况.结果 两组患者术前临床病理特征差异无统计学意义.胆管切开取石术组的手术时间、住院时间优于胆肠吻合术组(P＜ 0.05,P＜0.01);出血量、输血病例数、是否联合肝切除无明显差异.两组术后并发症发生情况差异无统计学意义.术前两组间肝脏生化指标(ALT、AST、GGT、ALP、ALB、TBIL、DBIL)无明显差异,术后胆肠吻合组ALP水平高于肝外胆管切开取石术组(P＜0.05).1年后胆管切开取石术组肝功能异常者明显少于胆肠吻合术组(14.6％ vs 31.5％,P＜0.01).胆管切开取石术组患者胆管积气、反流性胆管炎发作、胆管狭窄发生的比例显著低于胆肠吻合术组(1.0％ vs17.4％,4.0％ vs 24.0％,3.1％ vs 14.1％,P均＜0.01).两组间再手术率、结石复发率、癌变率等差异均无统计学意义.结论 治疗中度肝外胆管扩张合并Oddi括约肌功能正常的肝胆管结石病,肝外胆管切开取石术在胆管积气、反流性胆管炎、胆管狭窄发生率等方面优于Roux-en-Y吻合术.

Extrahepatic bile duct incision lithotomy versus Roux-en-Y cholangiojejunostomy for cholelithiasis with moderate extrahepatic bile duct dilatation and normal Oddi sphincter function

Objective To compare the efficacy of extrahepatic bile duct incision lithotomy versus cholangiojejunostomy in the treatment of cholelithiasis with moderate extrahepatic bile duct dilatation and normal Oddi sphincter function.Methods A retrospective study was carried out in 188 cholelithiasis patients with moderate extrahepatic bile duct dilatation and normal Oddi sphincter function,who underwent surgical treatment in Southwest Hospital from 2008 to 2013,including 96 patients undergoing extrahepatic bile duct incision lithotomy (group A) and 92 undergoing Roux-en-Y cholangiojejunostomy(group B).All the patients were followed up for over 3 years to assess their short-term outcomes (post-operative complications) and long term outcomes (cholangitis,bile duct stenosis,stone recurrence and canceration).Results There were no statistical differences in the clinicopathological features between groups A and B before the operations.The patients in group A had significantly shorter operative time (P ＜ O.01) and postoperative hospital stay (P ＜ 0.05) than those in group B,but the incidences of post-operative complications,amount of blood loss,cases requiring blood transfusion,and cases requiring hepatectomy were comparable between the 2 groups.There were no differences in the pre-operative serum levels of liver biochemical indicators (ALT,AST,GGT,ALP,ALB,TBIL and DBIL),but group B had a significantly higher postoperative ALP level than group A (P ＜ 0.05).At 1 year after operation,the patients in group A showed a lower incidences of abnormal liver function (4.6％ vs 31.5％,P ＜0.01),pneumobilia(1.0％ vs 17.4％,P ＜0.01),reflux cholangitis (4.0％ vs 24.0％,P ＜0.01) and biliary stricture after extrahepatic bile duct incision lithotomy (3.1％ vs 14.1％,P ＜ 0.01) than those in group B.The rates of reoperation,carcinogenesis and recurrent biliary stones were comparable between the 2 groups.Conclusion Extrahepatic bile duct incision lithotomy is superior to cholangiojejunostomy for treatment of cholelithiasis with moderate extrahepatic bile duct dilatation and normal Oddi sphincter function in terms of postoperative pneumobilia,reflux cholangitis and biliary stricture.