Rational selection and technical points of bilioenterostomy / 中华消化外科杂志

Bilioenterostomy with a wide variety of techniques is a common surgical operation in digestive surgery.Each of these surgeries has its own advantages and disadvantages.At present,Roux-en-Y choledochojejunostomy seems to be the dominant surgery,while other operations are used in some particular circumstances.Furthermore,some modified surgeries for bilioenterostomy have been conducted with the deepening understanding of the complications.Additionally,different kinds of new facilities and techniques have been applied to bilioenterostomy.Despite the controversy on specific issues,reasonable choice of bilioenterostomy should follow thc principles of specific purpose,correct choice and reliable effect.In other words,whether or not using bilioenterostomy should be considered correctly from the whole system,and then surgical methods should be accurately chose for patients,and finally avoiding the technical errors and guaranteeing the surgical effects.

Short and long term effects of the low-big hole choledochoduodenostomy / 中国综合临床

Objective To investigate the indications and clinical effect of the low-big hole choledochoduodenostomy. Methods Two hundred and ninty-eight patients, had bile duct stone accompanied with common bile duct lower segment stenosis, were prospectively enrolled into the study and randomly divided into the low-big hole choledochoduodenostomy (improved CD ) group (n = 148 ) and the Roux-en-Y choledochojejunostomy (CJ) group (n = 150). Their perioperative period and long term effect indices were recorded and compared. Results Perioperative period indices:The time of cholangio-jejunostomy was much shorter in improved CD group than the CJ group ([31.0±10.5] min vs [53.0±12.3] min, P＜0.001);The anastomotic leakage was significantly less in improved CD group than the CJ group (2 vs 9, P ＜ 0. 001 ). The long term effect indices: The occurrence of peptic ulcer (3 vs 15 ) and the bile duct cecum or blind loop syndrome (5 vs 158) were significantly lower in group improved CD group than CJ group (Ps＜0.01);The occurrence of bile duct backflow (70 vs 42) was significantly higher in improved CD group than CJ group (P＜0. 0l). Conclusion The clinical effect of the low-big hole choledochoduodenostomy gastrointestinal had excellent effect for bile duct stone accompanied with common bile duct lower segment stenosis, especially for old,weak and critical patients,and it can not be replaced by the Roux-en-Y choledochojejunostomy.