改良胆肠袢式吻合术治疗小儿胆管扩张症的疗效分析

摘要

Objetive To explore the clinical efficacy of a modified biliary-enteric loop type (Warren) anastomosis in treating biliary tract dilatation in children.Methods A retrospective analysis was made on 44 cases of biliary tract dilatation in children underwent surgery from Jan.2010 to Sep.2013.Methods loop-type biliary-enteric anastomosis were performed in 20 cases (test group)and biliary-enteric Roux-en-Y anastomosis in 24 cases (control group).The operation time for biliary-enteric anastomosis,patients'recovery time,liver function and postoperative complications between the 2 groups were compared.Results Operation time for bil-iary-enteric anastomosis and patients'recovery time were (63 ±11 min)and (21 ±4 h)in test group and (75 ±15 min)and (33 ±6 h)in control group,with statistical difference between the 2 groups(P <0.05).Except 1 case of adhesive intestinal obstruction in control group,there was no significant difference between the two groups in biliary drainage,jaundice elimination,postoperative complications and incidence of re-operation. Conclusions Compared with biliary-enteric Roux-en-Y anastomosis,the modified biliary-enteric (Warren)an-astomosis is a simple and reliable operation technique for biliary tract dilatation in children with better short-term outcomes.%目的：探讨改良胆肠袢式（Warren）吻合术重建胆道治疗小儿胆管扩张症的临床疗效。方法回顾性分析2010年1月至2013年9月我们收治的44例胆管扩张症患儿临床资料，其中20例行改良胆肠袢式（Warren）吻合术（改良组），24例行胆管空肠 Roux-en-Y 吻合术（Roux — Y 组）。比较两组手术时间、肠功能恢复时间、肝功能恢复情况及术后并发症情况。结果改良组平均手术时间（63±11）min，Roux—Y 组平均手术时间（75±15）min，差异有统计学意义（P ＜0.05）。改良组术后肠功能恢复时间（21±4）h，Roux—Y 组（33±6）h，差异有统计学意义（P ＜0.05）。两组肝功能恢复情况和退黄效果相同。除 Roux—Y 组有1例因肠粘连肠梗阻住院保守治疗后缓解外，两组均无返流性胆管炎等并发症。结论改良胆肠袢式吻合术重建胆道治疗小儿胆管扩张症的疗效与 Roux-en-Y 吻合术相同，但操作简便，术后肠功能恢复快。