中国实用外科杂志

中国实用外科杂志

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胃幽门离断联合胃空肠吻合术治疗胆总管十二指肠吻合术后反流性胆管炎效果分析

傅子轩，杨    俊，彭建东，廖雯俊，李恩亮，邬林泉   

  1. 南昌大学第二附属医院肝胆外科，江西南昌330006
  • 出版日期:2023-02-01

  • Online:2023-02-01

摘要： 目的    探讨采用胃幽门离断联合胃空肠吻合术治疗胆总管十二指肠吻合术后反复发作反流性胆管炎以及其他术后并发症的安全性和优势。方法    回顾性分析南昌大学第二附属医院 2016年 7 月至 2022年3月诊治的33例胆总管十二指肠吻合术后反复发作反流性胆管炎的病人资料，包括病人术前基本情况、实验室检查、手术时间、术中出血量及术后并发症等。均行手术治疗，手术方式分别采用胃幽门离断联合胃空肠吻合术（A组，13例）和传统的胆管空肠Roux-en-Y吻合术（B组，20例）。结果    A组与B组手术时间［（148.6±28.4 ）min vs.（188.1±32.5）min］及术后住院时间（10.6±2.9）d vs. （13.9±3.1）d相比较，组间差异有统计学意义（P＜0.05）；而术中输血病人例数（3例 vs. 5例）及住院费用［（44876.3±9736.0）元 vs. （51322.5±11849.1）元］，组间差异无统计学意义（P＞0.05）。A组治疗成功率92.3%（12/13），B组治疗成功率95.0%（19/20），差异无统计学意义（P＞0.05）。两组术后发生近远期并发症发生率差异无统计学意义（P＞0.05）。结论    针对胆总管十二指肠吻合术后反复发作反流性胆管炎的病人，采用胃幽门离断联合胃空肠吻合术不仅具有胆管空肠吻合手术相同的治疗效果，而且能缩短手术时间及住院时间。

关键词: 胆总管十二指肠吻合术 , 反流性胆管炎 , 胆管空肠吻合术, 胃幽门离断联合胃空肠吻合术, 术后并发症

Abstract: Treatment effect of gastropylorectomy combined with gastrojejunostomy on reflux cholangitis after choledochoduodenostomy        FU Zi-xuan, YANG Jun, PENG Jian-dong, et al. Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
Corresponding authors：LI En-liang，E-mail: lienliangyx@163.com；WU Lin-quan，E-mail: Wulqnc@163.com
Abstract    Objective    To investigate the safety and advantages of gastropylorectomy combined with gastrojejunostomy in treating postoperative complications of choledochoduodenostomy. Methods    The clinical data and follow-up of 33 patients with recurrent reflux cholangitis after choledochoduodenostomy admitted in the Second Affiliated Hospital of Nanchang University from July 2016 to March 2022 were analyzed retrospectively, including preoperative basic information, laboratory tests, operation time, intraoperative blood loss and postoperative complications. All patients underwent surgical treatment, including gastropylorectomy combined with gastrojejunal anastomosis (group A ,13 cases) and traditional choledochojejunostomy Roux-en-Y anastomosis (group B,20 cases). Results    The operation time (148.6±28.4 vs. 188.1±32.5) minutes and postoperative hospital stay (10.6±2.9 vs.13.9±3.1) days were statistically significant between A and B groups (P＜0.05). There were no significant differences in the number of intraoperative blood transfusion cases (3 vs. 5 cases) and hospitalization costs (44876.3±9736.0 vs. 51322.5±11849.1) yuan between the two groups (P>0.05). The success rate of treatment in group A and group B were 92.3%(12/13) and 95.0%(19/20),respectively (P>0.05). There were no significant postoperative complications in the two groups (P>0.05). Conclusion    For patients with recurrent reflux cholangitis after choledoduodenostomy, gastropylorectomy combined with gastrojejunostomy  has the same therapeutic effect as choledojejunostomy, but also shortens the operation time and hospital stay.

Key words: choledochoduodenal, reflux cholangitis, cholangiojejunostomy, gastropylorectomy combined with gastrojejunostomy, postoperative complication