皮下盲襻型胆管空肠吻合术在肝胆管结石治疗中的应用(附2100例报告)

Apply of choledochojejunostomy with subcutaneous blind loop in the treatment of hepatolithus(with report of 2100 cases).

目的总结皮下盲襻型胆管空肠吻合术在肝胆管结石中应用的经验和教训。方法回顾分析我科2100例肝胆管结石施行皮下盲襻型胆管空肠吻合术的治疗效果。结果全组均施行皮下盲襻型胆管空肠吻合术,其中肝门整形病灶切除术871例(41.5%)。全组患者发生出血、漏胆和感染并发症共51例(2.4%),死亡6例(0.3%),术后结石复发485例(23.1%)。结论皮下盲襻型胆管空肠吻合术是治疗肝胆管结石的基础。术中尽可能切除病灶,对狭窄的肝门部和二级胆管开口整形,皮下预留盲襻为结石复发做准备,以及充分发挥胆管镜的作用,将使治疗更加完善,效果更好。

Objective To summarize the surgical experiences and lessons of choledochojejunostomy with subcutaneous blind loop or the treatment of hepatolithus.Methods The clinical data and treatment effectiveness of 2100 patients with hepatolithus who had experienced choledochojejunostomy with subcutaneous blind loop in our hospital were retrospectively analyzed.Results The all cases were performed choledochojejunostomy with subcutaneous blind loop,and 871 cases were performed additional porta hepatic plastic operation with focus resection.The complications incidence was as low as 2.4% with 51 cases（hemorrage：0.4% with 9 cases,biliary fistula and infection：2% with 42 cases,）after operations.The mortality rate was 0.3% with 6 cases.The recrrence rate of hepatolithus was as low as 23.1% with 485 cases.Conclusion The choledochojejunostomy with subcutaneous blind loop is the groundwork of the treatment to hepatolithus.Resection to the focus,plastic operation to porta hepatic and the port of Ⅱ grade bile ducts,to place blind loop of jejunum against the recurrent hepatolithus,and maximized utilizations to the choledochoscope will improve the treatment effects to hepatolithus.