| BackgroundCholedochojejunostomy is one of the most common method of the reconstruction of biliary surgery in hepatobiliary surgery.But due to obstructive jaundice,some patients were re-admitted,the anastomotic stricture,bile duct stones and anastomotic tumors are the common reasons.For benign and malignant anastomotic stricture can be removed in different ways,such as balloon-assisted enteroscopy(BAE)with endoscopic retrograde cholangiopancreatography(ERCP),percutaneous transhepatic cholangioscopy(PTCS),percutaneous transhepatic cholangiography(PTC)with expandable metallic biliary endoprosthesis(EMBE)and biliary intestunaal anastomosis revascularization and so on,but some problems still can not be solved,such as to remove stones or solve the anastomotic stricture completely,the complication rate of cholangitis,bile duct scar stricture and recurrent calculus is still high,Multiple surgical treatments are needed to make patients with poor quality of life.For the phenomenon,It is still a thorny problem for hepatobiliary surgery that how to reduce the incidence of complications of anastomotic stricture with the recurrent calculi after choledochostomy.The basin-forming choledochojejunostomy proposed by Prof.Chen XP and his team is applied to the reconstruction of high bile duct obstruction due to its advantages of large anastomosis,low incidence of biliary fistula,and simple operation.Therefore,we discusse whether the modified basin-froming choledochojejunostomy is suitable for benign anastomotic stenosis after choledochojejunostomy.ObjectiveTo evaluate whether modified basin-forming anastomosis can be used to treat recurrent stone after choledochojejunostomy.MethodsA total of 112 patients suffering from biliary-intestinal anastomosis in our department from January 2013 to December 2018 were divided into tow groups,67 patients undergoing routine choledochojejunostomy were grouped into control,45 patients undergoing modified basin-forming biliary-intestinal anastomosis were allocated into study group.Results(1)General condition:There was no ststistically significant difference between two groups(P>0.05),which was comparable.(2)Preoperative fingdings:Control vs study group,total bilirubin,direct bilirubin and CA199 were(20.50±52.30)?mol/L vs(35.50±73.90)?mol/L,(12.70±42.60)?mol/L vs(17.00±56.80)?mol/L and(22.11±82.23)vs(30.98±236.60),with statistically difference(Z=2.63,3.08,2.01,P<0.05),alanine aminotransferase,aspartate aminotransferase,white blood cells,red blood cells,Child-Pugh grade a and b were,(53.00±73.50)vs(62.00±55.00)U/L,(37.70±54.00)vs(41.00 ±60.00)U/L,(8.29 ± 5.89)vs(9.02±5.38)109/L,(3.90±0.80)vs(3.60±1.00)1012/L,56vs 36 and 11 vs 9,with no statistically difference(Z=0.36,0.75,0.44,2.49,2.01,?2=0.23,P>0.05).(3)Intraoperative findings:Control vs study group,intraoperative blood loss,operative time and the number of patients with intraoperation transfusion were(300.00±150.00)ml vs(100.00±120.00)ml,(288.31±82.74)min vs(204.22±57.85)min and 20 vs 5,with statistically difference(Z=5.85,t=6.32,?2=5.54,P<0.05).The number of patients with liver resection were 16 vs 9,with on statistically difference(?2=0.23,P>0.05).(4)Postoperative efficacy:Control vs study group,total bilirubin and direct bilirubin one day after surgery,entered ICU,postoperative hospital stay and dmission after 30 days were(1.31±0.51)?mol/L vs(1.61±0.80)?mol/L,(11.70±21.20)?mol/L vs(26.70±44.70)?mol/L,9 vs 1,(13.00±7.00)d vs(13.00±6.00)d and 31 vs 11,with statistically difference(Z=1.99,2.56,?2=4.16,Z=2.84,x2=6.18,P<0.05),the number of patients with incision infection,biliary fistula and residual stones were 8 vs 2,9 vs 3 and 15 vs 3,with no statistically difference(?2=1.86,1.28,1.79,P>0.05).(4)Follow-up situation:All 112 patients were followed up for 10 to 36 mouths,(median time,23 mouths).The follow-up rate was 100%.There were no deaths during the perioperative period.ConclusionsThe modified basin-forming biliary-intestinal anastomosis is a simple,safe and effective surgical method for recurrent calculus after choledochojejunostomy. |
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