皮下通道型肝胆管狭窄成形术治疗肝内胆管结石的疗效评价

Clinical effects of subcutaneous tunnel hepatocholangioplasty on the treatment of hepatolithiasis

目的探讨皮下通道型肝胆管狭窄成形术治疗肝内胆管结石的疗效。方法回顾性分析1993年1月至2006年8月99例接受皮下通道型肝胆管狭窄成形术患者的临床疗效。其中结石局限于左肝28例(28.3%),右肝24例(24.2%),两肝均有47例(47.5%)。肝内胆管结石合并狭窄66例(66.7%)。手术方式为胆囊切除、肝内胆管结石取出、病肝切除、肝管狭窄纠正、肝门部胆管成形、与带蒂游离空肠吻合、盲襻皮下埋置。其中27例(27.3%)胆囊不切除,行成形肝管-胆囊颈部吻合,胆囊底皮下埋置。结果 95例获得随访,随访率96.0%。随访时间1个月～13.5年,平均4.2年。术后残石率为23.2%(23/99),结石复发率20.0%(19/95),术后胆管炎发生率14.7%(14/95)。其中34例经皮下通道引流或胆道镜取石,结石取净率为91.2%(31/34)。结论皮下通道型肝胆管狭窄成形术可有效降低结石及胆管炎复发,并可简单有效地处理再发结石。

Objective To evaluate the therapeutic effect of subcutaneous tunnel hepaticoplasty on the treatment of hepatolithiasis. Methods The early complications and clinical effects of 99 hepatolithiasis cases who underwent subcutaneous tunnel hepaticoplasty from January 1993 to August 2006 were analyzed retrospectively. The stones of 28 （28.3%） patients were in the left lobe, 24. 2% （24/99） in the right, and 47.5% （47/99） in bilateral lobe. Sixty-six patients （66. 7% ） had both stones and biliary strictures. During the procedure, a portion of the liver habouring stone was resected if nessesary. The hepatic duct and strictures were opened, the stones were removed, and the porta hepatis was repaired by one end of a segment of jejunum. The other end of the jejunum was set subcutaneously. The gall bladders of 27 patients （27. 3% ） were used as subcutaneous tunnel instead. Results Ninety-five out of ninety-nine cases were followed up with an average of 4. 2 years （1 month to 13.5 years）. The rates of residual stone, recurrent stone and cholangitis were 23.2% （23/99）, 20. 0% （19/95） and 14. 7% （14/95） respectively. Postoperatively, 34 cases who had residual or recurrent stones were underwent lithotomy by choledochoscope through the subcutaneous blind loop and the achievement ratio was 91.2% （31/34）. Conclusions Subcutaneous tunnel hepatocholangioplasty decreases the relapsing cholangitis effectively, and makes an easy way to take out residual or recurrent stones.