胆肠吻合术对胆总管结石合并0ddi括约肌关闭不全的临床效果研究  

Clinical effect of Roux-Y hepaticojejunostomy for choledocholithiasis combined with sphincter of Oddi insufficiency

作　　者：周红兵[1] 杨兴业[1] 陈曦[1] 袁寅[1] 

机构地区：[1]泰州市人民医院肝胆外科,江苏泰州225300

出　　处：《肝胆胰外科杂志》2017年第6期453-456,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨肝外胆管切除+胆肠Roux-Y吻合术及腹腔镜下胆囊切除+胆总管切开胆道镜取石+T管引流术治疗胆总管结石合并0ddi括约肌关闭不全的临床效果。方法 2013年1月至2014年1月期间泰州市人民医院对62例胆总管结石合并0ddi括约肌关闭不全患者采用两种不同手术方式进行治疗。其中41例行肝外胆管切除+胆肠Roux-Y吻合术,21例行腹腔镜下胆囊切除+胆总管切开胆道镜取石+T管引流术。比较两组术后近期并发症发生率,并重点随访两组远期并发症发生率。结果两组近期并发症(包括胆漏、切口感染、结石残留)发生率均无统计学差异(P>0.05)。出院后随访时间3~43个月,平均23个月。两组远期并发症(包括胆漏、切口感染、结石残留)发生率均无统计学差异(P>0.05)。胆肠吻合组术后结石复发率2.44%(1/40),LC+LCDBE组术后结石复发率38.1%(8/13),差异有统计学意义(P<0.05)。结论对术中胆道镜探查明确Oddi括约肌明显关闭不全,舒缩功能基本丧失,且胆总管扩张明显的患者,我们应该选择肝外胆管切除+胆肠Roux-Y吻合术以有效降低术后结石复发率,提高生活质量。Objective To discuss the clinical effect of extrahepatic bile duct resection＋Roux-Y hepaticojejunostomyand laparoscopic cholecystectomy＋laparoscopie common bile duct exploration in treatment of choledocholithiasiscombined with sphincter of Oddi insufficiency. Methods A total of 62 patients with choledocholithiasisand sphincter of Oddi insufficiency were collected from Jan. 2013 to Jan. 2014 in Taizhou People’s Hospital.Among them, 41 cases were treated with extrahepatic bile duct resection＋Roux-Y hepaticojejunostomy, and theother 21 cases were treated with laparoscopic cholecystectomy＋laparoscopie common bile duct exploration. Theincidence of postoperative complications between the two groups was compared, and the long-term complicationsbetween the two groups were also followed-up. Results There was no significant difference in the incidence ofshort-term post-operative complications （bile leakage, wound infection, and residual stones） between the twogroups （P〉0.05）. The rate of lithic recurrence was 2.44% （1/40） in the Roux-Y hepaticojejunostomy group, and38.1% （8/13） in the LC＋LCDBE group, the difference was statistically significant （P〈0.05）. Conclusion Whensphincter of Oddi insufficiency was clear during the choledochoscopy exploration, vasomotor function foundamentlylose, and the common bile duct obviously dilatates, we should choose the treatment of extrahepatic bileduct resection plus Roux-Y hepaticojejunostomy, to reduce the lithic recurrence rate after operation and improvethe quality of life.

关 键 词：胆总管结石 0ddi括约肌关闭不全 胆肠ROUX-Y吻合术 腹腔镜胆总管切开取石术 

分 类 号：R657.4[医药卫生—外科学]