皮下通道型胆囊肝胆管吻合术在治疗肝胆管结石及狭窄中的应用

Clinical effects of subcutaneous tunnel cholecystocholangiostomy in the treatment of hepatocholangiolithiasis and hepatic portal bile duct stenosis

目的 总结皮下通道型胆囊肝胆管吻合术 (STHG)的临床效果。方法 回顾性分析了 1994年以来 135例STHG手术患者的临床效果及术后胆囊功能、结构情况。结果 STHG术后早期无并发症发生 ;胆囊收缩与浓缩功能基本正常 ;胆囊黏膜色泽正常 ,无水肿、糜烂。结论 该术式既保存了胆囊及Oddi括约肌功能 ,又保证了胆汁的生理流向 ,防止了肠液的反流。同时 ,由于胆囊与肝内胆管可通过大的吻合口互相沟通 ,胆囊内浓缩胆汁可随时进入肝内胆管 ,提高肝内胆汁胆酸盐的浓度 ,从而起到溶解肝内胆管胆色素结晶、防止色素结石复发的作用。该术式对患者的影响小 ,同时为治疗复发结石预设了通道 ,并能预防结石形成 ,因此是一种较为理想的治疗肝胆管结石和肝门部胆管狭窄的术式。

Objective To summarize the clinical effects of cholecystocholangiostomy (STHG) in the treatment of hepatocholangiolithiasis and hepatic portal bile duct stenosis. Methods The early complications, clinical effects, and functions of gallbladder in a total of 135 patients, admitted since 1994 were for STHG were retrospectively analyzed. Results No early complications were observed after the operation. The contraction and concenration function of the gallblader remained basically normal. The color of gallbladder mucosa was normal,and no edema or erosion was found under choledochoscopy. Conclusions This operation not only maintained the normal physiological functions of the gallbladder and Oddi sphincter, but also the physiological flow of the bile, farthermere it prevented reflux of intestinal juice and reflax chdangitis. Because the anastomotic stoma was large, concentrated bile within the gallbladder could freely get access to the intrahepatic biliary tract, the concentration of bile acid in the intrahepatic bile duct was markedly elevated, so that the solubility of bilirubin crystal, was increased and recurrence of calculus formation eould be retarded. There fore, STHG should be considered to be an optimal operation in dealing with hepatocholangiolithiasis and biliary stenosis.