胆管空肠Roux-en-Y吻合联合皮下空肠盲袢埋藏术治疗肝胆管结石患者疗效研究  

Convenient clearance of recurred stone in patients with hepatolithiasis undergoing Roux-en-Y choledochojejunostomyand subcutaneous buried blind jejunal loop

作　　者：周红飞 陈钟[2] 顾宏 沙德胜 Zhou Hongfei;Chen Zhong;Gu Hong(Department of Hepatobiliary and Pancreatic Surgery,People's Hospital,Affiliated to Nantong University,Rugao 226500,Jiangsu Province,China)

机构地区：[1]南通大学附属如皋人民医院肝胆胰外科,江苏省如皋市226500 [2]南通大学附属医院肝胆外科

出　　处：《实用肝脏病杂志》2023年第4期584-587,共4页Journal of Practical Hepatology

基　　金：南通市科学技术局基础科学研究计划项目(编号:JCZ21150)。

摘　　要：目的观察采取胆管空肠Roux-en-Y吻合联合皮下空肠盲袢埋藏术治疗肝胆管结石患者的疗效及外周血T淋巴细胞亚群的变化。方法2012年1月~2021年6月我院收治的165例肝胆管结石患者,其中89例接受胆管空肠Roux-en-Y吻合术,另76例接受胆管空肠Roux-en-Y吻合联合皮下空肠盲袢埋藏术治疗。采用ELISA法检测血浆皮质醇(COR)水平,使用流式细胞仪检测外周血T淋巴细胞亚群。结果联合手术组手术时间为(258.5±36.7)min,显著长于吻合术组【(221.1±32.5)min,P<0.05】,而两组术中出血量、术后排气时间和住院日比较,无显著性差异【分别为(270.4±51.4)ml、(3.9±0.7)d和(8.0±1.4)d对(278.4±52.3)ml、(3.8±0.7)d和(7.3±0.7)d,P>0.05】;在术后1 w,联合手术组血清TBIL、ALT、GGT和COR水平分别为(16.5±3.8)μmol/L、(54.4±14.1)g/L、(184.3±34.2)U/L和(241.7±43.5)nmol/L,与吻合术组比无显著性差异【分别为(13.2±4.0)μmol/L、(49.6±12.4)g/L、(179.5±32.5)U/L和(242.7±44.0)nmol/L,P>0.05】;联合手术组外周血CD3^(+)和CD4^(+)细胞百分比及CD4^(+)/CD8^(+)细胞比值分别为(58.2±6.5)%、(37.2±4.3)%和(1.2±0.2),与吻合术组比无显著性差异【分别为(57.2±6.2)%、(36.4±4.3)%和(1.2±0.3),P>0.05】;联合手术组胆漏发生率为1.3%,显著低于对照组的10.1%(P<0.05);在术后1年,吻合术组结石率为10.1%,联合手术组为7.9%(P>0.05),后者经盲袢手术取石,得到清理。结论采取胆管空肠Roux-en-Y吻合联合皮下空肠盲袢埋藏术治疗肝胆管结石患者有助于方便快捷地清理复发结石,对机体无更多的不良影响。Objective The aim of this study was to observe the efficacy of Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop in the treatment of patients with hepatolithiasis.Methods A total of 165 patients with hepatolithiasis were admitted to our hospital between January 2012 and June 2021,and the Roux-en-Y cholangiojejunostomy was performed in 89 cases and the Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop was done in 76 cases.Plasma cortisol(COR)level was detected by ELISA,and the peripheral blood T lymphocyte subsets were measured by flow cytometry.Results The operation time in the combination surgery group was(258.5±36.7)min,much longer than[(221.1±32.5)min,P<0.05]in the anastomosis group,while there were no significant differences as respect to the intraoperative blood loss,postoperative exhaust time and hospital stay between the two groups[(270.4±51.4)ml,(3.9±0.7)d and(8.0±1.4)d vs.(278.4±52.3)ml,(3.8±0.7)d and(7.3±0.7)d,respectively,P>0.05];one week after the operation,serum bilirubin,ALT,GGT and COR levels in the combination group were(16.5±3.8)μmol/L,(54.4±14.1)g/L,(184.3±34.2)U/L and(241.7±43.5)nmol/L,not significantly different compared to[(13.2±4.0)μmol/L,(49.6±12.4)g/L,(179.5±32.5)U/L and(242.7±44.0)nmol/L,respectively,P>0.05]in the control;the percentages of peripheral blood CD3^(+)anc CD4^(+)cells as well as the ratio of CD4^(+)/CD8^(+)cells were(58.2±6.5)%,(37.2±4.3)%and(1.2±0.2),not significantly different as compared to[(57.2±6.2)%,(36.4±4.3)%and(1.2±0.3),respectively,P>0.05]in the control group;the incidence of bile leakage in the combination surgery group was 1.3%,much lower than 10.1%(P<0.05)in the control;one year after the operation,the recurrence rate of stone in the control group was 10.1%,and that was 7.9%(P>0.05)in the combination surgery group,and the stone was successfully removed by through the buried blind jejunal loop.Conclusion The Roux-en-Y choledochojejunostomy and subcutaneous buried blind jejunal loop is efficaci

关 键 词：肝胆管结石 胆管空肠ROUX-EN-Y吻合术 皮下空肠盲袢埋藏术 皮质醇 治疗 

分 类 号：R657.4[医药卫生—外科学]