肝胆管结石术中胆管引流方式合理选择

The reasonable option of biliary drainage for hepatolithiasis

肝胆管结石病的处理中,胆管引流至关重要。不恰当的胆道内引流会使病情更趋复杂,并给进一步处理带来不必要的困难。肝叶切除是治疗肝胆管结石的主要手段。在取净结石的前提下,应主要根据Oddi括约肌的功能状态以及胆总管的扩张程度来决定胆管引流方式,胆肠吻合的手术指征须严格控制。对于Oddi括约肌功能正常的病例,均应采用T管引流,无须行胆肠吻合。只有对确认胆总管下端炎性狭窄或Oddi括约肌松弛、合并胆总管高度扩张的病例,才有必要行胆肠吻合。

Biliary drainage plays a vital role in surgical management of hepatolithiasis. An improper enteric drainage not only complicate the situation but also create unnecessary problems for subsequent treatment. Hepatolobectomy remains the mainstay of curative treatment for hepatolithiasis. Based on the clearance of stone, a reasonable mode of biliary drainage should be decided according to the function of Oddi sphincter and the degree of expansion of bile duct. The indication of choledochojejunostomy should be strictly limited. T-tube drainage should be used in all patients with normal function of Oddi sphincter. Choledochojejunostomy is only necessary in those with distal biliary stricture or with the loss of function of Oddi sphincter combined with remarkable expansion of bile duct.