胆管对端吻合联合胆管空肠吻合术治疗高位胆管损伤疗效分析  

Analysis of the effect of bile duct end-to-end anastomosis combined with choledochojejunostomy in the treatment of proximal hepatic bile duct injury

作　　者：杨俊 傅子轩 李恩亮[1] 罗帅武 王聪 戈进 雷钧[1] 廖雯俊[1] 邬林泉[1] YANG Jun;FU Zi-xuan;LI En-liang(Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院肝胆外科,江西南昌330006

出　　处：《中国实用外科杂志》2021年第12期1400-1406,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81860431,No.82060447);江西省重点研发项目(No.20203BBGL73200);江西省重点研发项目(No.20181BBG70010)。

摘　　要：目的探讨高位胆管损伤的术区的显露,胆管对端吻合联合胆管空肠吻合术的安全性及优势。方法回顾性分析南昌大学第二附属医院2004年12月至2020年12月诊治的80例因胆囊及胆管手术并发的高位胆管损伤病人资料。胆管损伤病人均为Strasberg—Bismuth分型中对应为E2、E3、E4型损伤。结果术中发现并修复5例,治疗成功率60.0%;早期修复(≤2周)34例,治疗成功率79.4%;延期修复(>2周)41例,治疗成功率73.1%。胆管对端吻合联合胆管空肠吻合术(A组15例)与传统的胆管空肠吻合术(B组59例)相比较,A组与B组术后住院时间[(15.14±4.13)d vs.(20.22±9.27)d]及术后近期并发症总例数(2例vs.32例)组间差异有统计学意义(P<0.05),其中A组与B组胆漏例数(0例vs.13例),组间差异有统计学意义(P<0.05),两组病人术后远期并发症组间差异无统计学意义(P>0.05)。住院费用[(55344±12890)元vs.(65156±28707)元]差异无统计学意义。两组病人性别、年龄、合并基础疾病情况、术前内镜下鼻胆管引流术(ENBD)或经皮肝穿刺胆道引流术(PTCD)治疗、术前白蛋白水平、总胆红素水平、肝酶升高、白细胞计数、中性粒细胞百分比、美国麻醉医师协会(ASA)分级进行比较,组间差异无统计学意义(P>0.05)。A组与B组平均手术时间[(202.73±32.95)min vs.(190.26±39.32)min]、术中输血(4例vs.20例)、术中出血量[(212.00±226.66)mL vs.(225.42±238.33)mL]组间差异无统计学意义(P>0.05)。结论对于高位胆管损伤病人,部分肝切除显露术区可增加手术中胆管缝合的可靠性,胆管对端吻合联合胆管空肠吻合术这一术式较传统的胆管空肠吻合术具有缩短住院时间、减少术后并发症尤其是胆漏的发生等优势。Objective To investigate the exposure of the surgical area after proximal hepatic bile duct injury,and the safety and advantages of bile duct end-to-end anastomosis combined with choledochojejunostomy.Methods The clinical data and follow-up of 80 patients with proximal hepatic bile duct injury complicated by gallbladder and biliary surgeries admitted from December 2004 to December 2020 in the Second Affiliated Hospital of Nanchang University were retrospectively analyzed.Patients with bile duct injury were classified as E2,E3,and E4 in the Strasberg-Bismuth classification.Results Five cases were discovered and repaired during the operation,with a treatment success rate of60.0%.34 cases with early repaired(≤2 weeks),with a treatment success rate of 79.4%.41 cases with delayed repaired(>2 weeks),with a treatment success rate of 73.1%.Comparing bile duct end-to-end anastomosis combined with choledochojejunostomy(group A,n=15)with traditional choledochojejunostomy(group B,n=59),the postoperative hospital stay in group A and group B(15.14±4.13)vs(.20.22±9.27)days,total short-term postoperative complications(2 vs.32)cases.The difference in postoperative hospital stay and postoperative complications was statistically significant(P<0.05),among them,the number of cases of biliary leakage(0 vs.13)in group A and group B was statistically significant(P<0.05).There was no statistically significant difference in long-term postoperative complications between the two groups.And hospital costs(55344±12890)vs(.65156±28707)yuan,there was no significant difference in hospital costs between groups.The two groups of patients were compared by gender,age,underlying diseases,preoperative endoscopic nose biliary drainage(ENBD)or percutaneous transhepatic cholangial drainage(PTCD)treatment,preoperative albumin level,total bilirubin level,liver enzymes,white blood cell count,percentage of neutrophils,the American Standards Association(ASA)grade,and the difference between the groups was no significant(P>0.05).The average operation time

关 键 词：高位胆管损伤 手术时机 胆管空肠吻合术 胆管对端吻合联合胆管空肠吻合术 术后并发症 

分 类 号：R6[医药卫生—外科学]