Comparative Stuty On Application Of Circular Stapler In Patients With Biliary Obstruction Caused By Malignant Diseases Undergoing Choledochojejunostomy

Objective: To compare the efficacy and safety of circular stapler or manual anastomosis in patients with biliary obstruction caused by malignant diseases undergoing Roux-en-Y choledochojejunostomy,To explore the application value of circular stapler in Roux-en-Y cholangiojejunostomy.Methods: 1.This is a retrospective study.A total of 130 patients with biliary obstruction caused by malignant diseases undergoing Roux-en-Y choledochojejunostomy were evaluated.Patients were divided into stapler group and manual anastomosis group according to the anastomotic method.67 patients in the stapler group,63 patients in the manual anastomosis group.2.Outcome Measures: the incidence of bile leakage,the incidence of hemorrhage of biliary tract,the incidence of biliary stricture,the incidence of cholangitis,the incidence of cholelithiasis,anastomotic time,duration of operation,total intraoperative blood loss,direct bilirubin difference before and after operation,length of hospital stay after opreation.3.SPSS 25.0 is used for statistical analysis of experimental data.Descriptive analysis,Quantitative data consistent with the normal distribution with mean and standard deviation,does not meet the normal distribution using the median;qualitative data using frequency and percentage.The quantitative data between the two groups were compared bytwo independent samples t-test.Chi-square test was used for qualitative data.The difference between the two groups is statistically significant(P < 0.05).Results: 1.The incidence of bile leakage is signifcantly higher in the manual anastomosis group than the stapler group: 14.29% versus 2.99%(P=0.03).2.The anastomotic time is signifcantly shorter in the stapler group than the manual anastomosis group: 8.06±2.01(min): 17.03±1.50(min)(P=0.00),as was the total duration of operation: 147.09±32.23(min): 162.79±50.15(min)(P=0.037).3.There is no difference between groups in the incidence of hemorrhage of biliary tract,the incidence of biliary stricture,the incidence of cholangitis,the incidence of cholelithiasis,total intraoperative blood loss,direct bilirubin difference before and after operation,length of hospital stay after opreation.Conclusion: Circular stapler and manual anastomosis both have good effects in relieving biliary obstruction and reducing jaundice for the patients with biliary obstruction caused by malignant diseases undergoing Roux-en-Y choledochojejunostomy.Besids,The application of circular stapler in Roux-en-Y choledochojejunostomy can shorten the anastomotic time and the total duration of operation,and decrease the incidence of bile leakage.Therefore,the circular stapler deserve popularization in the patients with biliary obstruction caused by malignant diseases undergoing Roux-en-Y choledochojejunostomy.