CAJ | 학술논문

目的探讨胆总管十二指肠后壁大口径低位吻合术的适应证及临床效果.方法采用前瞻性随机对照方法研究我院298例胆管结石并胆总管下段狭窄患者,采用胆总管十二指肠后壁大口径低位吻合术(简称改良CD)治疗的患者148例,与同期行胆管空肠Roux-en-Y吻合术(CJ)150例比较围手术期指标和远期疗效指标.结果围手术期指标:吻合时间改良CD组显著少于DJ组分别为[(31.0±10.5)、(53.0±12.3)min,P＜0.001];吻合口瘘改良CD组显著少于DJ组(分别为2、9例,P＜0.05);远期指标:改良CD组与DJ组消化道溃疡分别为3、15例,盲端(攀)综合征分别为5 、158例,改良CD组显著少于CJ组(P均＜0.01);胆道返流分别为70、42例,改良CD组显著多于DJ组(P＜0.01).结论胆总管十二指肠后壁大口径低位吻合术治疗胆管结石并胆总管下段狭窄有较好的疗效,不能被Roux-en-Y取代;尤其适合老年、危重、体弱的胆管结石并胆总管远端良性狭窄患者.
목적 탐토담총관십이지장후벽대구경저위문합술적괄응증급림상효과.방법 채용전첨성수궤대조방법연구아원298례담관결석병담총관하단협착환자,채용담총관십이지장후벽대구경저위문합술(간칭개량CD)치료적환자148례,여동기행담관공장Roux-en-Y문합술(CJ)150례비교위수술기지표화원기료효지표.결과 위수술기지표:문합시간개량CD조현저소우DJ조분별위[(31.0±10.5)、(53.0±12.3)min,P＜0.001];문합구루개량CD조현저소우DJ조(분별위2、9례,P＜0.05);원기지표:개량CD조여DJ조소화도궤양분별위3、15례,맹단(반)종합정분별위5 、158례,개량CD조현저소우CJ조(P균＜0.01);담도반류분별위70、42례,개량CD조현저다우DJ조(P＜0.01).결론 담총관십이지장후벽대구경저위문합술치료담관결석병담총관하단협착유교호적료효,불능피Roux-en-Y취대;우기괄합노년、위중、체약적담관결석병담총관원단량성협착환자.
Objective To investigate the indications and clinical effect of the low-big hole choledochoduodenostomy. Methods Two hundred and ninty-eight patients, had bile duct stone accompanied with common bile duct lower segment stenosis, were prospectively enrolled into the study and randomly divided into the low-big hole choledochoduodenostomy (improved CD ) group (n = 148 ) and the Roux-en-Y choledochojejunostomy (CJ) group (n = 150). Their perioperative period and long term effect indices were recorded and compared. Results Perioperative period indices:The time of cholangio-jejunostomy was much shorter in improved CD group than the CJ group ([31.0±10.5] min vs [53.0±12.3] min, P＜0.001);The anastomotic leakage was significantly less in improved CD group than the CJ group (2 vs 9, P ＜ 0. 001 ). The long term effect indices: The occurrence of peptic ulcer (3 vs 15 ) and the bile duct cecum or blind loop syndrome (5 vs 158) were significantly lower in group improved CD group than CJ group (Ps＜0.01);The occurrence of bile duct backflow (70 vs 42) was significantly higher in improved CD group than CJ group (P＜0. 0l). Conclusion The clinical effect of the low-big hole choledochoduodenostomy gastrointestinal had excellent effect for bile duct stone accompanied with common bile duct lower segment stenosis, especially for old,weak and critical patients,and it can not be replaced by the Roux-en-Y choledochojejunostomy.