留置皮下通道多术式联合治疗肝内胆管结石

Treatment of hepatolithiasis by multiple operative methods with hepatico-subcutaneous stoma

目的:探讨留置皮下通道多术式联合治疗肝内胆管结石和狭窄的疗效及长期效果评价。方法:回顾性分析北京大学第三医院普通外科从1993年4月至2010年3月收治的肝内胆管结石符合做留置皮下通道的病例共156例,手术采用保留Oddi括约肌功能、肝门部胆管切开成形、狭窄纠正、病变肝组织切除和留置皮下通道的方式。结石位于左半肝占23.7%(37/156)、右半肝占14.1%(22/156)、左右半肝均有结石占62.2%(97/156),另外,结石合并狭窄占63.5%(99/156)。结果:所有患者均成功手术,无围手术期死亡,手术并发症发生率为35.9%(56/156)。146例获得随访,随访率94.8%,中位随访时间为7年,随访发现胆管炎发作者占13.0%(19/146),再发结石者占21.9%(32/146),新发现胆管狭窄者占8.2%(12/146),另外,利用皮下通道切开胆道置管引流、取石或狭窄支撑35例,占24.0%(34/146)。结论:留置皮下通道、保留Oddi括约肌功能、多术式联合治疗肝内胆管结石和狭窄的方法安全、有效,对再发结石和狭窄的处理符合微创。

Objective：To evaluate the mid-term and long-term outcomes of patients with hepatolithiasis after receiving multiple operative methods with hepatico-subcutaneous stoma.Methods：A retrospective analysis was performed based on 156 patients with hepatolithiasis who underwent multiple operative methods with hepatico-subcutaneous stoma from Apr.1993 to Mar.2010 in Peking University Third Hospital.Thirty-seven of them had stone in the left lobe（23.7%）,22 in the right lobe（14.1%）,and 97 in bilateral lobes（62.2%）.Ninety-nine patients had hepatolithiasis combined with biliary stricture（63.5%）.Results：All of the patients underwent successful operations and recovered well with no death in perioperative period.The rate of operative complications was 35.9%.A total of 146 patients were followed up with a median time of 7 years.The rate of patients with cholangitis,recurrent stone,and biliary stricture newly detected was 13.0%（19/146）,21.9%（32/146） and 8.2%（12/146）,respectively.Draining inflammatory bile and taking out recurrent stones by hepatico-subcutaneous stoma were carried out in 35 patients（24.0%）.Conclusion：Treatment of hepatolithiasis with biliary stricture and its recurrence by multiple operative methods with hepatico-subcutaneous stoma is safe,effective,minimally invasive,and easy to perform.