短Roux-Y空肠肝支在胆总管囊肿根治术中的应用  

Is 40-cm Roux Limb in the Radical Surgery for Choledochal Cyst Necessary?

作　　者：刘树立[1] 李龙[1] 黄柳明[2] 张军[1] 马立霜[1] 侯文英[1] 谢华伟[1] 王文晓[1] 崔龙[1] 张金山[1] 

机构地区：[1]首都儿科研究所小儿外科,北京100020 [2]北京大学第一医院小儿外科,北京100034

出　　处：《中国微创外科杂志》2010年第10期919-921,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：国家支撑计划课题:严重结构异常筛查;诊断和治疗规范化方案改进的研究(2006BAI05A06);首都医学特色项目课题:微创技术治疗先天畸形和肿瘤的临床研究

摘　　要：目的探讨小儿肝管空肠Roux-Y吻合术适宜的肝支肠管长度。方法 2001年2月~2008年7月胆总管囊肿根治术176例,根据胆道重建中Roux-limb长度分为2组。短Roux-limb组（S组）：120例,Roux-lmib长度15~20 cm;长Roux-limb组（L组）：56例,Roux-lmib长度35~40 cm。胆肠吻合后吻合口2组均无张力。结果 2组胆肠吻合术顺利。Roux-limb长度S组（17.3±1.7）cm显著短于L组（39.1±1.9）cm（t=76.291,P=0.000）。S组胆肠吻合时间（16.5±5.5）min与L组（15.4±3.9）min无统计学差异（t=1.346,P=0.188）;S组排气时间（24.7±6.7）h与L组（25.8±5.8）h差异无显著性（t=-1.057,P=0.292）;S组术后住院时间（7.4±2.2）d与L组（8.1±2.6）d差异无显著性（t=-1.853,P=0.066）。S组胆漏发生率2.5%（3/120）与L组1.8%（1/56）无统计学差异（χ2=0.000,P=1.000）;2组无胆肠吻合口狭窄。S组随访（35.8±17.8）月与L组（39.2±21.9）月差异无显著性（t=-1.095,P=0.275）。术后3个月,2组胆汁引流良好（总胆红素、直接胆红素正常,B超肝内胆管无扩张）;S组胆管炎发生率0.8%（1/120）与L组1.8%（1/56）无统计学差异（χ2=0.000,P=1.000）;S组肠梗阻发生率2.5%（3/120）与L组3.6%（2/56）差异无显著性（χ2=0.000,P=1.000）。结论在胆总管囊肿根治术中采用短Roux-limb进行胆肠吻合安全、可行,与长Roux-limb效果相同,短Roux-limb具有保留有效肠管,利于患儿生长发育的优点。Objective To compare the efficacy of the short and long Roux limbs in the treatment of choledochal cyst,and evaluate the efficacy and safety of short Roux-limb approach for patients with choledochal cyst. Methods From February 2001 to July 2008,176 patients with choledochal cyst underwent total cyst resection with Roux-en-Y hepatojejunostomy in our hospital.Of the patients,120 patients received short Roux-limb（≤ 15-20 cm） radical procedure（group S）,and 56 patients underwent long Roux-limb（≥ 35-40 cm） procedure（group L）.There were 80 girls and 40 boys [mean age：（44.2±24.3） months] in group S,and 40 girls and 16 boys [mean age：（43.6±23.5） months;t=0.154,P=0.878 compared with group S] in group L,respectively（χ2=0.399,P=0.528）.Data of liver function,liver ultrasound,and children＇s development were collected during follow-up.Results The operation was completed successfully in all the 176 patients without Roux-limb-related complications occurred.The mean length of Roux limb in the group S was significantly shorter than that in the group L [（17.3±1.7） cm vs（39.1±1.9） cm;t=76.291;P=0.000].While,no significant difference was found in the time of end-to-side cholangiojejunosotmy [（16.5±5.5） min in group S vs（15.4±3.9） min in group L,t=1.346,P=0.188],recovery time of gastrointestinal function [（24.7±6.7） h vs（25.8±5.8） h;t=-1.057,P=0.292],hospital stay [（7.4±2.2） d vs（8.1±2.6） d,t=-1.853,P=0.066],and rate of biliary leakage [2.5%（3/120） vs 1.8%（1/56）,χ2=0.000,P=1.000] between the groups.No anastomotic stenosis was found in either of the groups.The mean follow-up was（35.8±17.8） and（39.2±21.9） months respectively in groups S and L（t=-1.095,P=0.275）.Three months after the surgery,both the groups showed normal biliary drainage（both total and direct bilirubin were in a normal range,and B-ultrasonography showed no dilation of the intrahepatic bile ducts）.The two groups showed similar rates of cholangitis and intestinal obst

关 键 词：胆总管囊肿 肝管空肠吻合术 儿童 

分 类 号：R657.4[医药卫生—外科学]