| 摘 要： | PURPOSES: To evaluate the perioperative and long-term efficacy of modified choledochojejunostomy.
METHODS: Clinical data were collected from 143 eligible patients who had undergone choledochojejunostomy at the Eastern Hepatobiliary Surgery Hospital affiliated with the Second Military Medical University of China between January 2007 and December 2010 and retrospectively analyzed. Among the patients, 38 underwent choledochojejunostomy with a new method of anastomosis (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, time elapsed before the patients’ liquid food consumption, postoperative delayed gastric emptying, and liver function were evaluated in both groups.
RESULTS: There were no statistical differences in the levels of alaninetransaminase, alkaline phosphomonoesterase, and gamma-glutamyl transferase between two groups. The time elapsed before the patients could eat liquid food was significantly shorter in the IG group than in the CG group (P<0.05). The incidence of delayed gastric emptying tended to be lower in the IG group than in the CG group, although not to a statistically significant degree (P=0.052). Of the 9 patients with different degrees of acute cholangitis, one patient (2.6%) in the IG group and 8 (7.6%) in the CG group suffered from acute cholangitis within six months of discharge, but no statistically significant difference was found between the two groups (P>0.05). Of the 9 patients with acute cholangitis, none in the IG group but 4 in the CG group were hospitalized for further treatment (P>0.05).
CONCLUSION: The 38 consecutive IG patients experienced satisfactory perioperative and relatively long-term prognoses, requiring less time before they could begin to consume liquid food and show a lower incidence of delayed gastric emptying. In addition, the procedure of IG was simpler than that of CG, and patients had milder symptoms and a lesser frequency of reflux cholangitis. Therefore this new procedure of choledochojejunostomy by the route behind pyloric antrum was found to be safe, with zero mortality and a low rate of complications.
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