肝门部大口径胆肠吻合术治疗肝内胆管结石和狭窄(附40例报告)

Large caliber cholangio-jejunostomy at the hepatic hilum in treating hepatolithiasis and stricture of the intrahepatic biliary duct(s)

为了探讨治疗肝内胆管结石和狭窄的有效手术方法，在1985～1995年我们对40例肝内胆管结石及肝内胆管狭窄的病例施行肝门部大口径胆肠吻合术。40例中14例为肝内胆管多发结石，26例合并肝内胆管狭窄，狭窄好发于邻近肝门的1～2级肝内胆管开口，手术中充分切开肝门部的肝外胆管和1～2级肝内胆管分枝及其狭窄部，术中借助胆道镜检查及取石，并与空肠行一层外翻大口径RouX-en-Y型吻合。经9～69个月的随访结果表明，34例（85％）疗效优良。结果提示：肝门部大口径胆肠吻合术是一种治疗肝内胆管结石及肝内胆管狭窄较理想的手术。

To explore effective surgical procedure in treating hepatolithiasis and stricture of the intrahepatic binaryduct(s), from 1985 through 1995, 40 cases of hepatolithiasis accompanied with stricture of the intrahepatic binary duct(s) were treated with large caliber cholangio-jejunostomy at the hepatic hilum. 14 cases had multiple intrahepatic stonesand 26 cases were accompanied with binary duct stricture(s), which mainly occurred in grade one or two intrahepaticducts. During operation, the common and grade one to two intrahepatic binary ducts with strictures were incised, andwere anastomosed widely to the jejunum with single large eversion suture according to the Roux-en-Y technique. Duringoperation, intrahepatic stones were cleared up with the help of fibro-optic--cholangioscope. The result after follow-up of9 to 69 months revealed that 34 cases had an amelioration of symptoms after operation. It is suggested that large calibercholangio-jejunostomy at the hepatic hilum is one of ideal operations in treating hepatolithiasis and intrahepatiC biliaryduct stricture.