Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. Email:
Chin Med J (Engl). 2013;126(24):4633-7.
Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.
Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.
There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P < 0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P > 0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P > 0.05).
Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.
反流性胆管炎是 Roux-en-Y 胆肠吻合术后最常见的并发症。本研究旨在评估一种新的胆肠吻合术式在胆肠吻合术中的围手术期和长期疗效。
回顾性分析 2007 年 1 月至 2010 年 12 月期间在中国第二军医大学东方肝胆外科医院接受胆肠吻合术的 143 例患者的临床资料。其中 38 例连续采用新吻合术式（改良组，IG），105 例采用标准 Roux-en-Y 胆肠吻合术（对照组，CG）。比较两组患者胆管炎发生率、开始进液时间、术后胃排空延迟及肝功能变化。
两组患者丙氨酸转氨酶、碱性磷酸单酯酶和γ-谷氨酰转移酶水平差异无统计学意义。IG 组开始进液时间明显短于 CG 组（P < 0.05）。IG 组胃排空延迟发生率低于 CG 组，两组间差异有统计学趋势（P = 0.052）。两组中均有 9 例不同程度的急性胆管炎患者，IG 组中有 1 例（2.6%）和 CG 组中有 8 例（7.6%）在出院后 6 个月内发生急性胆管炎，但两组间无统计学差异（P > 0.05）。在 9 例急性胆管炎患者中，IG 组均未住院进一步治疗，CG 组有 4 例（P > 0.05）。
IG 组患者围手术期及长期预后良好，进液时间短，胃排空延迟发生率低。这种新的胆肠吻合术式在幽门后进行，操作简单安全，无死亡，并发症发生率低。
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