| Background:Cholangioenterostomy has always been an indispensable surgical method for the treatment of intrahepatic and extrahepatic bile duct stones,bile duct cystic dilatation,Oddi sphincter dysfunction,bile duct stenosis,benign bile duct and malignant tumor.However,due to the abnormal anatomical structure,normal intestinal electrophysiological activities and bile excretion are affected.As a result,a series of complications were caused,such as reflux cholangitis,recurrence of stones,anastomotic stenosis and so on.In order to reduce the complications and to deal with them,some new or improved methods have been developed.In 1988,Van Stiegmann first reported a new anastomotic procedure,"Uncut roux-en-y",which USES loop anastomosis without cutting off jejunum to simplify the operation and reduce postoperative reflux.In 1977,fang gan etal.reported a method of subcutaneous indwelling jejunal blind loop for the treatment of postoperative recurrent calculi.Minimally invasive surgery,simplicity,reduce complications,reduce patients' pain and improve the quality of life have become the development trend.Objective:1.The advantages and disadvantages of laparoscopic roux-en-y choledochojejunostomy combined with indwelling subcutaneous jejunal blind loop were compared with laparoscopic roux-en-y choledochojejunostomy combined with indwelling subcutaneous jejunal blind loop2.The advantages of Uncut roux-en-y choledochojejunostomy combined with indwelling subcutaneous jejunal blind loop were compared with those of laparoscopic Uncut roux-en-y choledochojejunostomy combined with indwelling subcutaneous jejunal blind loop.3.Discuss whether laparoscopic Uncut roux-en-y choledochojejunostomy combined with indwelling subcutaneous jejunal blind loop is safe,reliable and feasible,and worthy of clinical implementation.Method:Application were retrospectively analyzed,to collect the second affiliated hospital of kunming medical university from January 2014 to September 2018 for biliary diseases do open Roux-en-y biliary intestinal anastomosis joint indwelling subcutaneous jejunal loops of blind 23 patients(group A),line laparoscopic Roux-en-y biliary intestinal anastomosis joint indwelling subcutaneous blind jejunal loops(group B),20 cases and laparoscopic Uncut Roux-en-y biliary intestinal anastomosis joint indwelling subcutaneous blind jejunal loops(group C)in 20 patients.Preoperative,intraoperative and postoperative data of patients in group A,B and C were collected,and pairwise comparisons were made between group A and group B,and between group B and group C.T test was used for measurement data,chi-square test and rank sum test were used for counting data.Results:Preoperative:group A(roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop)had 23 patients,including 10 males and 13 females,aged 32-75 years,with an average age of 59.2±11.5 years.Group B(laparoscopic roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop)had 20 patients,including 5 males and 15 females,aged 18-83 years,with an average age of 51.2±17.3 years.Group C(laparoscopic Uncut roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop)included 20 patients,6 males and 14 females,aged 6-77 years,with an average age of 47.3±22.6 years.(1)after chi-square test,the results of the composition of diseases in groups A,B and C were as follows:group A was compared with group B,P>0.05;When comparing group B with group C,P>0.05 showed no statistical difference and the results were comparable.T test was used to compare age:group A(59.2±11.5)years old and group B(51.2±17.3)years old,P>0.05.Group B(51.2±17.3)years old and group C(47.3±22.6)years old,P>0.05,no statistical difference,with comparability.After the rank-sum test was applied to the Child grading of preoperative liver function in group A,B and C,P>0.05 was obtained for comparison between group A and group B,and P>0.05 was obtained for comparison between group B and group C.(3)the independent sample t test showed that the preoperative serum total bilirubin,serum albumin concentration and prothrombin time of the patients in group A,B and C were all P>0.05 after p2p3 comparison,with no statistical difference and comparability.Intraoperative:compared with group A,group B had less intraoperative bleeding(233.8±55.2)ml,(373.9 ±152.9)ml,P<0.05.Comparison between group C and group B:intraoperative blood loss was low(175.0±81.9)ml,(233.8±55.2)ml,P<0.05.Postoperative:compared with group A,early anal ventilation was the indication of rapid postoperative recovery of gastrointestinal function,(4.0±1.0)d,(4.6±1.9)d,P<0.05.Short hospitalization period(20.1 ± 5.9)d,(29.7±15.9)d,P<0.05;The total cost of hospitalization was low(3.6 ± 1.0)yuan,(6.1 ± 2.7)yuan,P<0.05.However,the operative time of laparoscopy group was significantly higher than that of laparotomy group:(322.3 ±34.1)min,(259.0±61.7)min,P<0.01.Comparison between group C and group B:early anal ventilation was associated with rapid postoperative gastrointestinal recovery(3.2±0.6)d,(4.0±1.0)d,P<0.05.Postoperative hospitalization days were short(16.7 ± 3.3)d,(20.1±5.9)d,P<0.05.The total cost of hospitalization was less(2.9± 0.6 thousand)and(3.6 ± 1.0 thousand),P<0.05.The operative time of group C(275.8±21.7)min was significantly shorter than that of group B(322.3±34.1)min,P<0.01.Compared with group A,B and C,the incidence of postoperative reflux cholangitis in group B was higher than that in group C,and there was no statistical difference in the incidence of postoperative incision infection rate and biliary fistula among the three groups.Conclusions:1.Compared with roux-en-y laparoscopic choledochojejunostomy combined with subcutaneous jejunal blind loop,laparoscopic roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop has the following advantages:small incision,less intraoperative bleeding,rapid postoperative recovery,short hospitalization period and low total hospital cost.However,due to the long operation time and complex operation,the promotion of this operation is limited.2.Laparoscopic Uncut roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop has the following advantages compared with laparoscopic roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop:shorter operation time,less intraoperative blood loss,faster postoperative recovery,shorter hospitalization period and lower total hospitalization cost,and more convenient operation method.3.Laparoscopic Uncut roux-en-y choledochojejunostomy combined with subcutaneous jejunal blind loop is safe,reliable,convenient and effective,which is worthy of clinical implementation. |
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