肝内胆管结石行保留Oddi括约肌的胆管狭窄整形术96例中长期随访报告

Mid-and Long-term Outcomes of Oddi Sphincter-preserved Cholangioplasty with Hepatico-subcutaneous Stoma(OSPCHS) for Hepatolithiasis:Report of 96 Cases

目的总结我院肝内胆管结石病行保留Oddi括约肌的胆管狭窄整形术（Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma,OSPCHS）96例中长期随访结果。方法回顾我院1994年6月~2006年12月肝内胆管结石病行OSPCHS后随访达3年以上96例的临床资料,报道OSPCHS术后胆管炎和与肝内胆管结石相关性腹痛复发病例的微创治疗结果及转归。结果96例中完全无症状的64例。症状复发32例,其中有与肝内胆管结石相关的腹痛13例,有胆管炎复发19例,胆管炎复发率为19.8%（19/96）。32例平均随访时间为8.1年（3~13.5年）。复发的原因包括残余胆道狭窄（5例）和残余结石（1例）,新结石的产生（18例）,新的良性胆道狭窄和结石（5例）以及肝门部胆管癌的发生（3例）。除3例拒绝进一步治疗外,16例经过切开皮下盲襻胆道镜治疗后继续随访3.2年无症状,10例有胆道狭窄合并结石（包括残余狭窄和新的狭窄）的仍然有胆管炎或腹痛症状,3例因罹患肝门部胆管癌死亡。结论OSPCHS术后结石和胆管炎复发的病例通过皮下盲襻切开胆道镜取石等治疗避免了再次开放的大手术。OSPCHS是治疗病变非局限化的肝内胆管结石病的最佳选择;处理胆道狭窄仍然是预防结石和胆管炎复发的关键。

Objective To summarize the mid-and long-term outcomes of patients with hepatolithiasis after receiving Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma（OSPCHS） in our hospital.Methods We reviewed 96 cases of hepatolithiasis,who underwent OSPCHS in our hospital from April 1993 to December 2006,with more than 3 years follow-up were reviewed.The outcomes of the recurrent cases who accepted minimal invasive treatment were recorded at the same time.Results Among the 96 cases,64 patients have been asymptomatic since the OSPCHS operation.The rest 32 patients had recurrent symptoms,19 of them（19.8%） suffered from recurrent cholangitis,and 13 had abdominal pain associated with hepatolithiasis.The average follow-up time was 8.1 years（3 to 13.5 years）.The recurrent causes included remnant biliary stricture（5 cases） and stone（1 case）,newly-formed stone（18 cases）,newly-formed stricture and stone（5 cases） and hilar cholangiocarcinoma（3 cases）.Three of the recurrent patients refused further treatment;the other 16 patients treated by cholangioscopy through the hepatico-subcutaneous stoma and have been asymptomatic for a mean of 3.2 years since then.Ten patients with remnant or newly-formed strictures still have symptoms of cholangitis or abdominal pain.Three patients died from hilar cholangiocarcinoma.Conclusions By cholangioscopy via the hepatico-subcutaneous stoma,open major surgery can be avoided for recurrent hepatolithiasis cases after OSPCHS.OSPCHS is the optimal option for the treatment of hepatolithiasis with non-localized hepatobiliary lesions.Management of biliary stricture is the determinant for the prevention of stone and cholangitis recurrence.