Oddi括约肌松弛合并胆总管结石复发的手术治疗体会

doi:10.3969/j.issn.10056483.2019.03.019

摘要/Abstract

摘要： 目的:探讨Oddi括约肌松弛合并胆总管结石复发的手术治疗方案。方法:胆总管复发结石合并Oddi括约肌松弛342例（均行数次胆道手术，胆囊均已切除），根据手术治疗方式不同分为三组，Ⅰ组281例，行横断胆管+胆肠RouxenY吻合术，Ⅱ组40例，行开腹或腔镜胆总管切开取石+T管引流术，Ⅲ组21例，行ERCP术，比较3种手术方式的治疗效果。结果:Ⅰ组结石复发率、胆管炎发生率均低于Ⅱ组和Ⅲ组（P<0.05），复发平均时间则晚于Ⅱ组和Ⅲ组（P<0.05），而Ⅱ组和Ⅲ组结石复发率、胆管炎发生率及复发平均时间比较差异无统计学意义（P>0.05）。胆肠 RouxenY吻合术的治疗总有效率高于胆总管切开取石+Ｔ管引流术和ERCP术（P<0.05），而胆总管切开取石术治疗总有效率与ERCP术比较差异无统计学意义（P>0.05）。结论:横断胆管+胆肠RouxenY吻合术是目前治疗Oddi括约肌松弛合并复发胆管结石较有效的手术方案。

关键词: Oddi括约肌松弛, 复发性胆管结石, 胆管炎, 胆肠吻合术

Abstract:

Objective:To explore a reasonable surgical treatment for Oddi sphincter relaxation complicated with recurrent choledocholithiasis.Methods:342 patients with choledocholithiasis complicated with Oddi sphincter relaxation disease（all underwent several biliary operations，including cholecystectomy） to receive surgical treatment in cholangiopancreatic surgery were selected as research object.According to the surgical treatment in different ways，these patients were divided into three groups：bile duct transection + RouxenY anastomosis（group Ⅰ，281 cases），holedocholithotomy and T tube drainage by laparotomy or endoscopy（group Ⅱ，40 cases），ERCP operation（group Ⅲ，21 cases），compared with three groups of different surgical methods of treatment.Results:The calculi recurrence rate and the incidence of cholangitis in Ⅰ group were significantly lower than that in Ⅱ group and Ⅲ group（P<0.05），and the average recurrence time was significantly later than that of Ⅱ group and Ⅲ group（P<0.05），while there was no significant difference between Ⅱ group and Ⅲ group about the calculi recurrence rate，recurrence of cholangitis rate and average time（P>0.05）.The total effective rates of cholangioenterostomy was significantly higher than that of choledocholithotomy and ERCP（P<0.05），while there was no significant difference between the total effective rate of choledocholithotomy and ERCP（P>0.05）.Conclusion:Transection of bile duct and bile duct RouxenY anastomosis is an effective surgical treatment for Oddi sphincter relaxation combined with recurrent bile duct stones.

Key words: sphincter of Oddi laxity, recurrent bile duct stones, cholangitis, choledochojejunostomy

柳德兵, 申铭, 郑建伟. Oddi括约肌松弛合并胆总管结石复发的手术治疗体会[J]. 临床外科杂志, 2019, 27(3): 236-238.

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