改良胆肠吻合术在治疗高龄恶性梗阻性黄疸患者中的应用研究

目的：探讨改良Roux-en-Y胆肠吻合术治疗高龄恶性梗阻性黄疸患者的安全性、有效性及其优势。方法：回顾性分析我院2007年6月—2010年6月收治的21例70岁以上恶性梗阻性黄疸患者的临床资料,分为传统手术组和改良手术组。比较二组患者的手术时间、肠功能恢复时间、住院时间、减黄疗效、返流性胆管等及并发症发生的情况。结果：采用改良Roux-en-Y胆肠吻合术治疗患者的手术时间、术后住院时间及肠功能恢复时间较传统治疗明显缩短,返流性胆管炎发生率亦显著减少,差异有统计学意义（P〈0.05）;二种术式的减黄效果无明显差异（P〉0.05）。结论：改良Roux-en-Y胆肠吻合术治疗高龄恶性梗阻性黄疸是安全有效的方法,不仅操作简单,而且有利于患者术后器官功能康复。

Application of improved Roux-en-Y choledochojejunostomy in elderly patients with malignant obstructive jaundice

Objective： To investigate the effectiveness,safety and advantages of the improved Roux-en-Y choledochojejunostomy（IRC） in elderly patients with malignant obstructive jaundice compared with traditional surgical treatment.Methods： From June 2007 to June 2010,21 patients who was over 70 years with malignant obstructive jaundice and underwent the operations of choledochojejunostomy were analyzed in retrospect,13 patients underwent the IRC,and 8 patients had the classic Roux-en-Y choledochojejunostomy（CRC）.We observed the completion time of the biliary jejunal anastomosis,the return of the flatus after the operation,the hospital stay after the operation,the reflux cholangitis,the resolution of jaundice and complications.Results： The anastomotic time of the IRC is shorter than that of the CRC（P0.05）.The return of the flatus of the patients after the operation who underwent the IRC are earlier than the patients who underwent the CRC,and the difference is significant（P0.05）.The patients of the the IRC groups need less time to recover after the operation（P0.05）.The decrease to the level of the total bilirubin in the serum of patients between two groups have no significant difference（P0.05）.Conclusions： The IRC is a safe and effective method to the elderly patients with malignant obstructive jaundice and can accelerate the organ recovery.