Abstract:
Objective To compare the clinical effect of three kinds of biliary reconstruction methods for congenital bile duct dilatation: hepatic duct jejunum Roux-Y anastomosis, modified hepatic duct jejunum Roux-Y anastomosis, and hepatic duct jejunum Roux-Y anastomosis+rectangle flap operation.
Methods From October 2010 to July 2013, ninety patients with congenital biliary dilatation in the Central Hospital of Enshi Autonomous Prefecture were selected and randomly divided into group A (hepatic jejunum Roux-Y anastomosis), group B (modified hepatic jejunum Roux-Y anastomosis) and group C (hepatic jejunum Roux-Y anastomosis+ rectangular flap surgery), with 30 cases in each group. The total effective rate, anti-reflux effect, operation time, blood loss, hospitalization time, the incidence of recent complications and the total incidence of long-term complications were compared between the three groups after long-term follow-up.
Results The total effective rates of group B and group C were 93.3% and 96.7%, which were higher than 73.3% in group A, the difference was statistically significant (Z=10.881, P<0.01). The incidence of reflux cholangitis in group B and group C were 13.3% and 10.0%, lower than 36.7% in group A (χ2=7.917, P=0.019). There were no significant differences in operation time, blood loss and hospitalization time among the three groups (F=0.795, 2.217, 2.919, P=0.454, 0.115, 0.059). The incidence of recent complications in group A, B, C were 26.7%, 20.0% and 13.3% respectively, with no statistically significant difference (χ2=1.667, P=0.435). After 1.5-4 (2.8±1.2) years of follow-up, the total incidence of long-term complications in group C was 13.3% (4/30), which was lower than that in group A (43.3%, 13/30) and group B (40.0%, 12/30), the difference was statistically significant (χ2=7.428, P=0.024).
Conclusion The application of Roux-Y anastomosis and rectangular flap surgery in hepatic duct jejunum in congenital biliary dilatation has good anti-reflux effect and less long-term complications, and the effect is ideal.
Key words:
Portoenterostomy,
Bile duct diseases,
Congenital cholangiectasis,
Long-term complication,
Follow-up
Dongzhou Xiang, Kangtai Wang, Zongyao Lu, Li Feng, Tao Zhang, Huilin Mao, Yintao Ke. Comparative study of the therapeutic effect of different biliary tract reconstruction methods in the treatment of congenital cholangiectasis[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(04): 255-259.