转移胆管瓣修补肝门胆管狭窄在肝胆管结石治疗中的应用

Application of biliary flap transposition hilar biliary stricture repair in treatment of hepatolithiasis

背景与目的:肝胆管结石病病情复杂,术后复发率高,需反复多次手术。在病程晚期可继发胆汁性肝硬化、甚至肝内胆管癌等,严重影响患者生活质量。本研究主要探讨转移胆管瓣修补肝门胆管狭窄在肝胆管结石治疗中的安全性和效果。方法:回顾性分析2016年1月1日—2018年12月31日湖南省人民医院收治的36例肝门部胆管狭窄患者的临床资料。观察患者手术时间、术中失血量、术后住院时间、术后并发症、吻合口再狭窄情况。结果:8例患者为首次手术,另28例患者曾行胆囊切除、胆总管探查等手术1~4次,所有患者均采用转移胆管瓣修补肝门部胆管狭窄,行胆管盆式Roux-en-Y内引流术。其中合并右后叶切除3例、左肝外叶切除6例,肝方叶切除11例。无围术期死亡病例。手术历时(256.4±98.2)min,术中失血量(218.5±68.1)mL,术后住院(10.3±3.2)d;3例(8.3%)术后发现残余少量结石;术后出现轻微胆汁漏1例,不完全性肠梗阻1例,腹腔积液2例,胸腔积液2例,均保守治疗治愈,未出现Clavien-Dindo IIIa级以上并发症。所有患者出院后采用门诊、电话随访,中位随访时间23.6(12~46)个月。2例出现反流性胆管炎,均自行缓解,未发现有吻合口再狭窄的患者;3例(8.3%)发现结石复发。结论:转移胆管瓣修补肝门胆管狭窄治疗肝胆管结石安全有效,可供临床借鉴。

Background and Aims:Hepatolithiasis is a complicated pathological condition,with a high postoperative recurrence rate,requiring repeated operations.In the late course of the disease,biliary cirrhosis and even intrahepatic cholangiocarcinoma may occur,which seriously affect the patients’ quality of life.This study was conducted to investigate the safety and efficacy of biliary flap transposition hilar biliary stricture repair in treatment of hepatolithiasis.Methods:The clinical data of 36 patients with hilar biliary stricture treated in Hunan Provincial People’s Hospital from January 1,2016 to December 31,2018 were retrospectively analyzed.The clinical variables that included the operative time,intraoperative blood loss,hospitalization time,postoperative complications,and anastomotic restenosis observed.Results:Of the patients,8 cases had the initial surgery,and the other 28 cases had surgery such as cholecystectomy,and common bile duct exploration once to 4 times previously.All patients underwent hilar biliary stricture repair by biliary flap transposition,and biliary basin Roux-en-Y internal drainage.Meanwhile,3 cases underwent the right posterior lobe resection,6 cases underwent the left lateral lobe resection,and11 cases underwent the quadrate lobe resection.No perioperative death occurred.The average operative time was (256.4±98.2) min,the average intraoperative blood loss was (218.5±68.1) mL,and the average length of hospital stay was (10.3±3.2) d.After operation,residual stones were found in 3 cases (8.3%),mild bile leakage occurred in 1 case,partial intestinal obstruction occurred in 1 case,abdominal fluid collection occurred in 2 cases,and pleural effusion occurred in 2 cases,which were all resolved by conservative treatment,and no complication greater than Clavien-Dindo IIIa was noted.All patients were followed up by outpatient examination and telephone interview.The median follow-up time was 23.6 (12–46) months.Reflux cholangitis occurred in 2 patients,which were spontaneously resolved,and no anastomotic restenosis was found.Stone recurrence was found in 3 cases (8.3%).Conclusion:Biliary flap transposition hilar biliary stricture repair is safe and effective for the treatment of hepatolithiasis,and it can be used for reference in clinical paractice.