Comparative Study On The Treatment Effect Of Pedicled Umbilical Vein Graft Repair Surgery Versus Choledochojejunostomy In Patients With Benign Biliary Stricture

Research background:Recently,the cases of benign biliary stricture caused by surgery,chronic inflammation and Composite abdominal trauma were increasing by years.Choledochojejunostomy always leads to Intestinal juice reflux and intrahepatic inflammation since the function failure of Oddi sphincter,although it is the most common surgical method for benign biliary stricture.The methods of repairing biliary stricture mainly include: direct plastic repair,end-to-end anastomosis,pedicled gallbladder wall repair,pedicled gastric antrum front wall repair and jejunum wall tissue petal transplant,and all the methods have their deficiencies respectively.The direct plastic repair may cause recurrent stricture.The end-to-end anastomosis needs suitable biliary tract and high technical requirement.The pedicled gallbladder wall repair is limited by many patients have a history of gall bladder surgery excision.The pedicled stomach sinus and jejunum wall transplantation to reconstruct the bile duct,which can cause other organ damage.Recent year,taking advantage of biological materials to repair the bile duct defect is the research focus.Pedicled umbilical vein graft is the perfect bile duct repairing material and pedicled umbilical vein graft repair is a safe and effective method.Since 1986,we have already used this method to repair bile bile duct stricture and defect and it did not been used widely.There is no Comparative study between pedicled umbilical vein graft repair and choledochojejunostomy,although there are a few case reports and prognosis of investigations.Above all,we make a Comparative study between pedicled umbilical vein graft repair surgery and choledochojejunostomy in patients with benign biliary stricture.Objective:1.To summarize and evaluate the safety,feasibility and efficacy of applying value and long-term effect of bile duct injury with pedicled umbilical vein graft repair compare with choledochojejunostomy.2.To find safe and reliable method for repairing biliary stricture to solve Intestinal juice reflux and intrahepatic inflammation after choledochojejunostomy for the patients.Methods:The clinica1 data of choledochojejunostomy or a pedicled umbilical vein graft to repair the stricture in the extrahepatic bile duct in 139 cases(25 cases of pedicled umbilical vein graft repair and 114 cases of choledochojejunostomy)from January 1 999 to December 2013 were retrospectively analyzed.During a follow-up period of 56.7±46.3 months,occurrence time of adverse events have been recorded including bile duct inflammation symptom(such as bile duct pneumatosis,abdominal pain,fever and jaundice),recurrent stricture,calculus recurrence,canceration and reoperation.Results: There are no statistical differences between pedicled umbilical vein tube repair group and biliary enteric anastomosis group in the aspects of preoperative case characteristics,the condition of patients during the perioperative period,the complications,postoperative restenosis rate,reoperation rate,stone recurrence rate and cancerous rate.The pedicled umbilical vein tube repairing have more advantages in improving biliary tract infection caused by Juice reflux.The Results of the two groups has statistically significant difference: postoperative biliary pneumatosis(P = 0.014),postoperative cholangitis(P = 0.047),postoperative fever(P = 0.047).It is exactly effective in treatment of benign biliary stricture caused by inflammatory,iatrogenic and traumatic factors using the two operation modes,which is safe,effective and simple.Conclusion: The pedicled umbilical vein tube repair is better than biliary enteric anastomosis in the matter of the retrograde infection of biliary tract owing to destroying Oddi sphincter.