胆总管十二指肠大口径低位吻合术治疗老年胆总管结石  

Low-big-hole choledochoduodenostomy in elderly patients with common duct stones

作　　者：陈生贵[1] 黄琼芳[2] 张乙川[1] 王俊[1] 李劲[1] 张福鑫[1] 

机构地区：[1]四川攀枝花学院附属医院肝胆外科,四川攀枝花617000 [2]四川攀枝花学院附属医院肛肠科,四川攀枝花617000

出　　处：《中华普外科手术学杂志（电子版）》2011年第3期24-26,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨胆总管十二指肠大口径低位吻合术治疗老年胆总管结石的临床效果。方法回顾性分析77例老年胆管结石并胆总管下段狭窄患者,采用胆总管十二指肠大口径低位吻合术(改良CD)治疗患者32例与同期行胆管空肠Roux-en-Y吻合术(CJ)45例患者比较围手术期指标和远期疗效指标。结果吻合时间改良CD组显著少于CJ组,P<0.01;吻合口瘘、术中出血量、术后感染、围手术期死亡、住院时间,两组差异无统计学意义,P>0.05;胆道返流改良CD组显著多余CJ组,P<0.01;胆道感染、吻合口狭窄、盲端(袢)综合征、结石复发、再手术等术后并发症差异无统计学意义,P>0.05。结论改良CD治疗老年胆管结石并胆总管下段狭窄近期疗效优于CJ,但远期疗效相当,CJ不能被取代。Objective To investigate the clinical effect of low-big-hole choledochoduodenostomy in elderly patients with common duct stones.Methods Seventy-seven patients suffered common duct stones with lower segment stricture of the common bile duct.Of these patients,32 underwent low-big-hole choledochoduodenostomy（CD group）,and 45 underwent choledochojejunostomy（CJ group）.The results of the two groups were compared in terms of perioperative index and prognosis.Results The operative time of cholangio-jejunostomy in the CD group was much shorter than in the CJ group,P0.01.The amount of bleeding,postoperative infection,deaths during the perioperative period and the length of stay in the hospital were more comparable in the CD group than in the CJ group,P0.05.The backflow of the bile duct in the CD group was higher than that in the CJ group,P0.01.Blind loop syndrome,infection of the biliary tract,stenosis of cholangio-jejunostic stoma and the recurrence of stone in the CD group were more comparable than in the CJ group,P0.05.Conclusions Low-big-hole choledochoduodenostomy is more appropriate for elderly or critical patients with bile duct stones associated with lower segment stricture of the common bile duct than Roux-en-Y choledochojejunostomy,but long-term therapeutic effect is equal,and it can not be replaced by Roux-en-Y choledochojejunostomy

关 键 词：胆总管造口术 胆总管结石 手术后并发症 吻合术 ROUX-EN-Y 

分 类 号：R657.4[医药卫生—外科学]