| Objective The application of Roux-en-Y cholangiojejunostomy in the treatment for hepatolithiasis was compared by propensity score matching.The safety and clinical effect of two Roux-en-Y cholangiojejunostomy were evaluated to provide evidence-based medical basis for further promotion.Methods From January 1,2015 to December 31,2018,710 patients with hepatolithiasis were treated by laparoscopic and open choledochojejunostomy in the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital).Among them,59 patients were treated by Roux-en-Y laparoscopic choledochojejunostomy(18 patients and 41 patients,respectively);651 cases of Roux-en-Y choledochojejunostomy group(121 cases and 530 cases of Roux-en-Y choledochojejunostomy for the first time and 530 cases for the second time)were compared with each other according to the nearest matching method(1:1)by using the data including the baseline data of patients,the previous upper abdominal operation history,the presence or absence of complications(cardiovascular disease,biliary cirrhosis,diabetes,cerebrovascular disease)Equipped,caliper value is 0.01.After matching,Roux-en-Y cholangiojejunostomy was performed for the first time(endoscopy group vs laparotomy group)in each group,and Roux-en-Y cholangiojejunostomy was performed again(endoscopy group vs laparotomy group)in each group,41 cases in each group.After matching and balancing the data of the two groups,the operation time,intraoperative bleeding volume,postoperative hospital stay time and postoperative complications were collected and analyzed to compare their safety.The clinical effect of reoperation due to the stricture of choledochojejunostomy was evaluated by quality of life scale.Results After matching,Roux-en-Y cholangiojejunostomy was performed for the first time(endoscopy group vs laparotomy group)in 18 cases in each group,and Roux-en-Y cholangiojejunostomy was performed again(endoscopy group vs laparotomy group)in 41 cases in each group.1.Preoperative data comparison: 1.Preoperative data comparison There was no significant difference between the two groups(P < 0.05).2.Intraoperative observation index(1)Roux-en-Y cholangiojejunostomy was performed for the first time(endoscopy vs laparotomy)The operation time was(283.06 ± 23.21)min vs(258.33 ± 28.54)min,and the intraoperative blood loss was(78.33 ± 29.36)ml vs(145.56 ± 39.29)ml.compared with the laparotomy group,the operation time of Roux-en-Y choledochojejunostomy in the endoscopic group was longer(P = 0.007),and the intraoperative blood loss was less(P = 0.000).(2)Roux-en-Y cholangiojejunostomy was performed again(endoscopy vs laparotomy)The operation time was(322.44 ± 21.77)min vs(309.02 ± 33.23)min,and the intraoperative bleeding volume was(146.10 ± 48.52)ml vs(173.42 ± 63.473)ml.compared with the laparotomy group,the operation time of Roux-en-Y choledochojejunostomy in the endoscopic group was longer(P = 0.034),while the intraoperative bleeding volume was less(P = 0.031).3.Comparison of postoperative observation indexes(1)Roux-en-Y cholangiojejunostomy was performed for the first time(endoscopy vs laparotomy)Postoperative hospitalization time(endoscopic vs open group):(8.83 ± 1.62)days vs(11.78 ± 4.17)days,there was statistical significance between the two groups.Compared with the open group,the hospitalization time of endoscopic group was shorter(P = 0.008).Comparison of postoperative complications(endoscopic vs open group): 2 cases(11.1%)vs 6 cases(33.3%).Compared with the open group,the incidence of postoperative complications in the endoscopic group was lower(P = 0.018).There was statistical significance between the two groups,but there was no significant difference between the two groups in different types of complications.(2)Roux-en-Y cholangiojejunostomy was performed again(endoscopy vs laparotomy)The postoperative hospitalization time(endoscopy group vs open group)(10.95 ± 2.52)vs(12.15 ± 2.52)days,there was statistical significance between the two groups.Compared with the open group,the hospitalization time of Endoscopy Group was shorter(P = 0.035).Comparison of postoperative complications(endoscopic vs open group): 4 cases(9.8%)vs 11 cases(26.8%).Compared with the open group,the incidence of postoperative complications in endoscopic group was lower(P = 0.005).There was statistical significance between the two groups,but there was no significant difference between the two groups in different types of complications.4.Efficacy comparison:(1)Roux-en-Y cholangiojejunostomy was performed for the first time(endoscopy vs laparotomy)Reoperation for choledochojejunostomy stenosis: 2 cases in endoscopic group were due to choledochojejunostomy stenosis.There was no significant difference in the quality of life scale score(80.67 ± 3.88)points vs(78.06 ± 3.17)points,indicating that the quality of life in the endoscopic group was higher than that in the open group(P = 0.034).(2)Roux-en-Y cholangiojejunostomy was performed again(endoscopy vs laparotomy)Reoperation for choledochojejunostomy stenosis: one case in endoscopic group was reoperation for choledochojejunostomy stenosis.One case of anastomotic stenosis was operated again in the open group.The difference was not statistically significant(P = 1.000);the score of quality of life scale(endoscopic group vs open group):(79.95 ± 3.69)points vs(77.98 ± 2.73)points,indicating that the quality of life in endoscopic group was higher than that in open group(P = 0.007).Conclusion Laparoscopic Roux-en-Y cholangiojejunostomy has the same effect in hepatolithiasis as that in the open group,and has the advantages of less intraoperative bleeding,quick postoperative recovery and high quality of life. |
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