| Objective:The advantages and disadvantages of Roux-en-Y choledochojejunostomy and modified loop anastomosis were compared;The advantages and disadvantages of the same operation in laparotomy and laparoscopy were compared,so as to provide a more valuable and reasonable reference scheme for the selection of choledochojejunostomy my。Method:A total of 573 patients who underwent choledochojejunostomy in the Second Hospital of Jilin University from January 2010 to September 2021 were retrospectively analyzed,and the clinical data of 179 patients were screened for this study.Among them,84 patients underwent open Roux-en-Y anastomosis,53 patients underwent open modified loop anastomosis,25 patients underwent laparoscopic Roux-en-Y anastomosis,and 17 patients underwent laparoscopic modified loop anastomosis,Intra-group and inter-group comparisons were performed.Collect clinical data from patients,Including gender,age,having merged basic diseases（hypertension,diabetes,coronary heart disease）,with and without history of abdominal adhesions,Child grading,jaundice in patients with preoperative diagnosis,liver function,different yellow reduction measure,prothrombin time,serum albumin,hemoglobin,common bile duct width,intraoperative situation,operation time,intraoperative blood loss,postoperative complications（bile leakage,peritoneal effusion,Wound infection,gastric paralysis）,time of first exhaust,time of gastric tube removal,time of total fluid feeding,time of abdominal drainage tube removal,length of hospital stay,cost of hospital stay,laboratory tests（total bilirubin and direct bilirubin before surgery,the first,third and fifth days after surgery）,etc.Result:Preoperative data:Compared with the patients’gender,age,underlying disease,history of abdominal adhesion,liver function Child grade,anemia,preoperative yellowing,albumin,prothrombin time,and common bile duct width,preoperative basic data did not affect the choice of Roux-en-Y and improved ansa anastomosis,all P>0.05.Two kinds of open choledochojejunostomy were compared:the modified loop anastomosis group was better than the Roux-en-Y anastomosis group in operation time（P=0.044）,peritoneal effusion（P=0.022）,bile leakage（P=0.024）,first exhaust time（P=0.021）,gastric tube extraction time（P=0.039）,eating time（P=0.015）,tube time（P=0.041）,hospital stay（P=0.035）,bleeding volume,wound infection,gastroparesis There was no significant difference between the two groups in terms of hospitalization expenses.The two groups were compared:the laparoscopic modified loop anastomosis group was better than the laparoscopic Roux-en-Y anastomosis group in operation time（P=0.048）,peritoneal effusion（P=0.002）,bile leakage（P=0.044）,first exhaust time（P=0.031）,gastric tube extraction time（P=0.038）,eating time（P=0.043）,tube time（P=0.035）and hospital stay（P=0.024）There was no significant difference in wound infection,gastroparesis and hospitalization expenses between the two groups.Compare the open Roux-en-Y anastomosis group with the laparoscopic Roux-en-Y anastomosis group:the laparoscopic Roux-en-Y anastomosis group is superior to the open Roux-en-Y anastomosis group in operation time（P=0.031）,bile leakage（P=0.039）,first exhaust time（P=0.005）,gastric tube extraction time（P=0.025）,eating time（P=0.014）,tube time（P=0.036）,hospital stay（P=0.044）and hospitalization cost（P=0.002）,There was no significant difference between the two groups in intraoperative bleeding,peritoneal effusion,wound infection and gastroparesis.Comparison between open modified loop anastomosis and laparoscopic modified loop anastomosis:the laparoscopic modified loop anastomosis group was better than the open modified loop anastomosis group in operation time（P=0.041）,bile leakage（P=0.041）,first exhaust time（P=0.036）,gastric tube extraction time（P=0.026）,eating time（P=0.038）,tube time（P=0.042）and hospital stay（P=0.039）There was no significant difference between the two groups in peritoneal effusion,wound infection,gastroparesis and hospitalization expenses.Laboratory indexes:the laboratory indexes of the two types of choledochojejunostomy were compared by repeated measurement analysis of variance:alanine aminotransferase:ALT,Levene homogeneity test（P>0.05）,it meets the variance homogeneity test,and the sphericity test P=0.001<0.05,dissatisfied with the football shape test,the multivariable test was carried out,and it was concluded that the time point*operation interaction effect was not significant,(F（3,26）=1.32,P=0.289>0.05),indicating that the two methods have no effect on the change of alanine aminotransferase.Aspartate aminotransferase:AST,variance Levene homogeneity test,P>0.05,it meets the variance homogeneity test,and the sphericity test P=0.001<0.05,dissatisfied with the football shape test,the multivariable test was carried out,and it was concluded that the time point*operation interaction effect was not significant,(F（3,26）=0.338,P=0.798<0.05),indicating that the two methods have no effect on the change of aspartate aminotransferase.Total bilirubin:TBIL was tested for variance Levene homogeneity（P>0.05）,it meets the variance homogeneity test,and the sphericity test P=0.001<0.05,dissatisfied with the football shape test,the multivariable test was carried out,and it was concluded that the time point*operation interaction effect was not significant,（F（3,26）=2.025,P=0.135>0.05）,indicating that the two methods have no effect on the change of total bilirubin.Direct bilirubin:the variance Levene homogeneity test of DBil（P>0.05）,it meets the variance homogeneity test,and the sphericity test P=0.001<0.05,dissatisfied with the football shape test,the multivariable test was carried out,and it was concluded that the time point*operation interaction effect was not significant,(F（3,26）=1.780,P=0.176>0.05),indicating that the two methods have no effect on the change of direct bilirubin.Conclusion:1.Compared with Roux-en-Y cholangiojejunostomy,the modified loop anastomosis has a lower incidence of complications such as bile leakage,peritoneal effusion,wound infection and gastroparesis.It is better than Roux-en-Y cholangiojejunostomy in terms of operation time,intraoperative bleeding,postoperative gastrointestinal function recovery,hospital stay and hospital cost.2.Compared with open cholangiojejunostomy,laparoscopic cholangiojejunostomy has the advantages of low incidence of postoperative complications,small surgical trauma,light pain and fast recovery,but the operation time is relatively long and the operation cost is relatively high.However,with the extensive development of laparoscopic surgery and the progress of laparoscopic technology,the operation time of laparoscopic cholangiojejunostomy will be gradually shortened. |
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