肝肠吻合术治疗复杂高位胆管狭窄的临床疗效  

Hepato-intestinal anastomosis in the treatment of complex stricture of high bile duct

作　　者：田广金 李德宇 余海波 董亚东 魏艳奎 代坤甫 薛焕洲 Tian Guangjin;Li Deyu;Yu Haibo;Dong Yadong;Wei Yankui;Dai Kunfu;Xue Huanzhou(Department of Hepatobiliary Pancreatic Surgery, Henan Province People＇s Hospital, Zhengzhou 450003, Chin)

机构地区：[1]郑州大学人民医院河南省人民医院肝胆外科,450003

出　　处：《中华普通外科杂志》2018年第4期318-321,共4页Chinese Journal of General Surgery

摘　　要：目的探讨肝肠吻合术治疗复杂高位胆管狭窄的临床疗效。方法收集2010年1月至2016年12月88例复杂高位胆管狭窄患者的临床资料，其中43例患者行常规胆肠吻合术（对照组），45例患者行肝肠吻合术（观察组）。结果（1）两组患者术中情况：对照组和观察组胆肠吻合时间分别为（24±3）min、（15±3）min（t=12．48，P〈0．05）；出血量（384±51）ml、（280±41）ml（t=10．46，P〈0．05），输血量（649±3）ml、（454±8）ml（t=144．65，P〈0．05）；输血分别10例、3例（χ^2=43．68，P〈0．05）；肝脏切除分别8例、3例（χ^2=49．50，P〈0．05）2组比较差异均有统计学意义。（2）术后疗效：对照组和观察组发热、切口感染、腹腔感染、胆瘘、非计划再人院患者分别为7例比3例、5例比3例、5例比2例、7例比3例、7例比3例，术后住院时间（14．3±1．5）d比（10．7±0．7）d．两组比较差异有统计学意义（分别χ^2=52．55，58．91，62．23，52．55，52．55，t=16．28，均P〈0．05）。（3）随访情况：所有患者均获随访，随访时间6～96个月，中位时间30个月。对照组和观察组分别有5例、1例患者胆管再狭窄，差异有统计学意义（χ^2=65．64，P〈0．05）。结论肝肠吻合术可有效治疗复杂高位胆管狭窄。Objective To evaluate hepato-intestinal anastomosis in the treatment of complex stricture of high bile duct. Methods From Jan 2010 to Dec 2016, 43 patients undergoing traditional biliary-intestinal anastomosis were grouped into control, 45 patients undergoing hepato-intestinal anastomosis were allocated into study group. Results （ 1 ） Control vs study grounp, the operative time was （ 24 ± 3 ）min vs. （15 ±3 ）min, intraoperative blood loss and blood transfusion were （384 ± 51 ）ml vs. （280 ± 41 ）ml, （649±3）ml vs. （454 ± 8）ml, number of patients with intraoperative blood transfusion, and liver resection were 10 vs. 3, and 8 vs. 3 respectively, with statistically differences （ t = 12.48, 10. 46, 144. 65, χ^2= 43.68, 49. 50, all P 〈 0. 05 ）. （ 2 ） Postoperatively efficacy ： fever was in 7 vs. 3 cases, incision infection in 5 vs. 3 cases, abdominal infection was in 5 vs. 2 cases, biliary fistula was in 7 vs. 3 cases, number of un-planed readmission was in 7 vs. 3 cases, and postoperative hospital stay were （ 14. 3 ± 1.5 ） d vs. （ 10. 7 ± 0. 7 ）d, respectively, between the control group and the study group, with statistically differences （χ^2 =52.55, 58.91, 62.23, 52.55, 52.55, t=16.28, allP〈0.05）. （3） Follow-up situation： all the 88 patients were followed-up for 6 to 96 months （ median time, 30 months）. Biliary restenosis occurred in 5 vs. 1 patients between the control group and the study group, respectively, with statistically differences （χ^2 = 65.64, P 〈 0.05 ）. Conclusions Hepato-intestinal anastomosis is effective in the treatment of complex stricture of high bile duct.

关 键 词：胆管肠吻合术 肝 手术后并发症 胆管狭窄 

分 类 号：R657.4[医药卫生—外科学]