关键词: 肝胆管结石, 胆管空肠Roux-en-Y吻合术, 皮下空肠盲袢埋藏术, 皮质醇, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop in the treatment of patients with hepatolithiasis. Methods A total of 165 patients with hepatolithiasis were admitted to our hospital between January 2012 and June 2021, and the Roux-en-Y cholangiojejunostomy was performed in 89 cases and the Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop was done in 76 cases. Plasma cortisol (COR) level was detected by ELISA, and the peripheral blood T lymphocyte subsets were measured by flow cytometry. Results The operation time in the combination surgery group was (258.5±36.7) min, much longer than [(221.1±32.5)min, P<0.05] in the anastomosis group, while there were no significant differences as respect to the intraoperative blood loss, postoperative exhaust time and hospital stay between the two groups [(270.4±51.4)ml, (3.9±0.7)d and (8.0±1.4) d vs.(278.4±52.3)ml, (3.8±0.7)d and (7.3±0.7)d, respectively, P>0.05]; one week after the operation, serum bilirubin, ALT, GGT and COR levels in the combination group were (16.5±3.8)μmol/L, (54.4±14.1)g/L, (184.3±34.2)U/L and (241.7±43.5)nmol/L, not significantly different compared to [(13.2±4.0)μmol/L, (49.6±12.4)g/L, (179.5±32.5)U/L and (242.7±44.0)nmol/L, respectively, P>0.05] in the control; the percentages of peripheral blood CD3⁺ anc CD4⁺ cells as well as the ratio of CD4⁺/CD8⁺ cells were (58.2±6.5)%, (37.2±4.3)% and (1.2±0.2), not significantly different as compared to [(57.2±6.2)%, (36.4±4.3)% and (1.2±0.3), respectively, P>0.05] in the control group; the incidence of bile leakage in the combination surgery group was 1.3%, much lower than 10.1%(P<0.05) in the control; one year after the operation, the recurrence rate of stone in the control group was 10.1%, and that was 7.9%(P>0.05) in the combination surgery group, and the stone was successfully removed by through the buried blind jejunal loop. Conclusion The Roux-en-Y choledochojejunostomy and subcutaneous buried blind jejunal loop is efficacious in the treatment of patients with hepatolithiasis, which might be convenient for repeated removal of residual stones and recurrent stones.

Key words: Hepatolithiasis, Roux-en-Y choledochojejunostomy, Subcutaneous buried blind jejunal loop, Cortisol, Therapy