改良胆肠Roux-en-Y吻合术在治疗恶性梗阻性黄疸中的应用

摘要

目的 探讨改良Roux-en-Y胆肠吻合术治疗胆道恶性梗阻的效果及临床应用价值.方法 回顾性分析36例胆道恶性梗阻需行胆肠吻合术患者的临床资料,其中行改良Roux-en-Y胆肠吻合术21例(改良组),同期行经典Roux-en-Y胆肠吻合术15例(经典组).改良Roux-en-Y胆肠吻合术在传统袢式吻合的基础上作了两项改进:①不切断空肠,输入袢和输出袢之间行侧侧吻合;②近段输入袢空肠结扎,阻断肠内容物进入肠道.观察两组手术时间、肠功能恢复时间、住院时间、返流性胆管炎减黄疗效及并发症发生情况.结果 改良组术中胆肠吻合时间、术后住院时间及肠功能恢复时间明显缩短,返流性胆管炎发生率显著减少,差异有统计学意义(P<0.05),两组术后减黄效果均明显,但组间比较无明显差异(P＞0.05).结论 改良Roux-en-Y胆肠吻合术操作简单、术后恢复快,尤其适用于高龄无法行根治性手术的恶性胆道肿瘤患者,值得临床推广应用.%Objective To explore the effectiveness and the value of clinical applications the improved Roux-en-Y cholangiojejunostomy in treating malignant obstructive jaundice. Methods A retrospective study was applied in 36 cases of biliopancreatic obstruction, in whom 21 cases underwent the improved Roux-en-Y cholangiojejunostomy, and 15 cases underwent the classic Roux-en-Y cholangiojejunostomy. The modified Roux-en-Y biliary-enteric anastomosis made two improvements based on the traditional one: ①Side to side anastomosis between the input and output loops with ont jejunectomy ;②Proximal jejunal loop ligation to block the entrance of the intestinal contents. Result The operation time, the bowel function recovery time and the hospitalization time were significantly reduced in the improved Roux-en-Y cholangiojejunostomy group (P ＜0.05 ).Conclusion It is recommended of the improved Roux-en-Y cholangiojejunostomy of the advantages of simple operation and quick postoperative recover, which may be especially suitable for the elderly.