CAJ | 학술논문

目的:探讨经改良后的胆总管十二指肠吻合术，在胆肠吻合中的疗效及应用价值。方法:对15例行Billroth Ⅱ式胃大部切除术后，十二指肠残端与胆总管进行吻合的病例资料进行回顾分析，并进行术后疗效的随访观察。结果:本组15例经8个月至14年（平均随访8年）的远期随访，无1例发生吻合口狭窄及胆道逆行感染。随访中3例因症状复发而再次手术，但术后证实无1例症状是由吻合口狭窄或逆行感染引起。结论:行Billroth Ⅱ式胃大部切除术后，将排外的十二指肠与胆总管吻合，可克服胆肠返流、胆道逆行感染、吻合口慢性牵拉造成狭窄等缺点，具有手术安全性大、术后并发症少、可大大缩短手术时间等优点，尤其适用于年老体弱、病情危重、且有多次上腹部手术史的病人。但产生盲端综合征的问题可能依旧存在，值得以后在吻合术式的选择中进一步探讨。
목적:탐토경개량후적담총관십이지장문합술，재담장문합중적료효급응용개치。 방법:대15례행Billroth Ⅱ식위대부절제술후，십이지장잔단여담총관진행문합적병례자료진행회고분석，병진행술후료효적수방관찰。결과:본조15례경8개월지14년（평균수방8년）적원기수방，무1례발생문합구협착급담도역행감염。수방중3례인증상복발이재차수술，단술후증실무1례증상시유문합구협착혹역행감염인기。결론:행Billroth Ⅱ식위대부절제술후，장배외적십이지장여담총관문합，가극복담장반류、담도역행감염、문합구만성견랍조성협착등결점，구유수술안전성대、술후병발증소、가대대축단수술시간등우점，우기괄용우년로체약、병정위중、차유다차상복부수술사적병인。단산생맹단종합정적문제가능의구존재，치득이후재문합술식적선택중진일보탐토。
Objective：To discuss the clinical effect and value of modified choledochoduodenostomy.Methods：We retrospectively analyzed fifteen cases after subtotal gastrectomy Billroth Ⅱ. These patients received choledocho-duodenal stump anastomosis and were followed up for an average of eight years.Results：None of the 15 cases suffered from stricture of the anastomosis stoma or retrograde biliary infection. Three cases accepted reoperation but none was because of stricture or retrograde infection.Conclusion：Choledochoduodenostomy after subtotal Billroth Ⅱ gastrectomy is reliable operation, which can prevent entero-biliary reflux and retrograde biliary infection. It also prevents anastomosis stricture induced by chironic drawing. So this operation is safet with, rare complications, so it is suitable for elder and serious patients, or for postoperation of upper abdomon. But the complication of blind loop syndrom still exits, which should be explored in future studies.