摘要
目的探讨有腹部手术史的梗阻性黄疸患者行改良胆肠襻式吻合术治疗的安全性、有效性及其优势。方法回顾性分析中山大学附属第一医院及潮州市中心医院2006年8月至2016年12月间收治的231例梗阻性黄疸患者临床资料,患者均有腹部手术史,根据手术方式分为传统组(128例,传统胆肠吻合术)和改良组(103例,改良胆肠襻式吻合术)。比较两组患者的手术时间、术中出血量、肠功能恢复时间、术后住院时间、减黄疗效及并发症发生的情况。结果与传统组相比,改良组患者的胆肠吻合时间、术中出血量、术后住院时间及肠功能恢复时间明显缩短,差异有统计学意义(t=11.882、3.726、7.332、12.076,均P<0.01)。两组患者术前血清总胆红素水平差异无统计学意义(t=-0.663,P=0.507),术后1、3、7 d血清总胆红素水平均逐渐下降,改良组的血清总胆红素水平下降幅度较传统组显著,减黄效果更好(F=4.384,P=0.043)。改良组患者术后近期并发症发生率亦显著减少(11.7%vs 39.1%,χ~2=21.841,P<0.01),远期效果与传统组相当(χ~2=0.009,P=0.925)。结论改良胆肠襻式吻合术治疗有腹部手术史的梗阻性黄疸是安全有效的方法,不仅操作简单,而且有利于患者术后康复。
Objective To investigate the effectiveness, safety and advantages of the improved Roux-en-Y choledochojejunostomy in obstructive jaundice patients with history of abdominal surgery. Methods From August 2006 to December 2016, two hundred and thirty-one patients with obstructive jaundice who had history of abdominal surgery and underwent the choledochojejunostomy were analyzed retrospectly. The patients were divided into traditional group（128 cases） and modified group（103 cases） according to the operation mode. The completion time of the biliary jejunal anastomosis, amount of bleeding, return of the flatus after the operation, hospital stay after the operation, resolution of jaundice and complications were observed between two groups. Results Compared with the traditional group, the time of intestinal anastomosis, amount of intraoperative bleeding, postoperative hospital stay and recovery time of intestinal function were significantly shorter in the modified group, the difference was statistically significant（t=11.882, 3.726, 7.332, 12.076, all P〈0.01）. There was no significant difference in serum total bilirubin level between the two groups before operation（t=-0.663, P=0.507）. The serum total bilirubin levels decreased gradually at 1, 3 and 7 d after operation, the level in the modified group was significantly lower than that in the traditional group, with better effect of reducing jaundice（F=4.384, P=0.043）. The incidence of postoperative complications was significantly reduced in the modified group（11.7% vs 39.1%, χ^2=21.841, P〈0.01）, and the long-term effect was similar to that of the traditional group（χ^2=0.009, P=0.925）. Conclusion For obstructive jaundice patients with history of abdominal surgery, the improved Roux-en-Y choledochojejunostomy is a safe and effective method, which is not only easy to operate, but also beneficial to postoperative rehabilitation.
作者
詹泽锋
陈伟
洪建文
黄鑫
林健群
Zhan Zefeng Chen Wei Hong Jianwen Huang Xin Lin Jianqun(Department of General Surgery, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521000, China Department of Biliary Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China)
出处
《中华普通外科学文献（电子版）》
2017年第4期269-272,共4页
Chinese Archives of General Surgery(Electronic Edition)
基金
潮卫科研经费资助项目(201512)
关键词
胆管肠吻合术
肝
黄疸
阻塞性
病史记录
腹部手术
Portoenterostomy
hepatic
Jaundice
obstructive
Medical history taking
Abdominal surgery
