胆肠吻合不放支撑引流管的临床研究  

Clinical research on cholangioenterostomy without stent tube drainage

作　　者：范作升[1] 李杰[2] 李兆然 居建华[1] 杜守业 王亮[1] 

机构地区：[1]山东省高密市人民医院普通外科,山东高密261500 [2]山东省千佛山医院肝胆外科,山东济南250012

出　　处：《中国普通外科杂志》2005年第8期573-576,共4页China Journal of General Surgery

基　　金：山东省科技厅医学研究基金立项课题(2001BB1BGB1)。

摘　　要：目的探讨胆肠吻合不放支撑引流管的可行性。方法比较52例高位胆管空肠吻合不放支撑引流管患者(A组)和56例放置支撑引流管患者(B组)的临床治疗恢复过程、术后随访和再手术情况。结果A组的胆瘘发生率为5.8%(3/52),B组为3.6%(2/56),两者差异无显著性(P>0.05);禁食、治疗用药和住院时间A组较B组短(P<0.01);术后感染并发症和水电紊乱A组较B组低(P<0.05)。术后随访A组和B组的胆管炎发作、结石再发、腹腔粘连和再次手术分别为4.4%,20.4%(P<0.05);2.2%,8.16%(P>0.05);4.4%,20.4%(P<0.05);2.2%,16.3%(P<0.05)。B组的8例再手术中有4例再发结石,5例次胆肠吻合口炎性增生、硬化。结论改进和提高胆肠吻合技术,不放支撑引流管是安全、可行的,且术后并发症少,恢复快,近远期疗效佳,患者易接受。Objective To investigate the feasibility of cholangioenterostomy without stent tube drainage. Methods In this study 52 cases anastomosed without stent tube drainage （ group A ） and 56 cases with stent tube drainage （ control , group B ） were included. The patients ＇ course of therapy and recovery , postoperative follow-up and reoperation were compared between group A and B. ResuIts The rate of bile leakage was 5.8% （3/52） in group A and 3.6% （2/56） in group B, respectively , which was not significant（ P 〉 0.05 ）. In group A the length of time of fasting, use of drug therapy and hospital stay of patients was significantly shorter（ P 〈 0.01 ） and the postoperative complications were lower（ P 〈 0.05 ） than those in group B. On postoperative follow-up, the rates of biliary infection, recurrence of gallstone, adhesions and reoperation of group A and B were 4. 4% and 20. 4% （ P 〈 0. 05） , 2. 2% and 8. 16% （ P 〉 0.05） , 4.4% and 20.4% （ P 〈 0.05） , 2.2% and 16. 3% （ P 〈 0.05） , respectively. In group B there were 8 reoperated cases, of which 4 cases had recurrent gallstones, and 5 cases had inflammatory hyperplasia and sclerosis of the anastomosis. ConcIusions and with improvement in technique of anastomosis is safe complications, faster recovery and satisfactory long-results Cholangioenterostomy without stent tube drainage, and effective. This method has less postoperative and is easily accepted by patients.

关 键 词：胆管肠吻合术 引流术 对比研究 

分 类 号：R657.4[医药卫生—外科学] R615[医药卫生—临床医学]