胆肠吻合术后肝胆管再发结石的手术治疗:附7例典型病例

Surgical treatment of recurrent hepatolithiasis after cholangiojejunostomy:A report of 7 typical cases

目的 总结和探讨胆肠吻合术后肝胆管再发结石的手术治疗经验。方法 回顾性分析2006年1月至2022年12月昆山市中医医院收治的7例典型胆肠吻合术后肝胆管再发结石患者的临床资料。7例患者肝胆管再发结石的部位均不相同。根据再发结石的部位及肝内外胆管狭窄情况选择不同的手术方式,包括残余胆管切除、胆肠吻合重建、胆道镜探查、肝段切除、半肝切除及多种术式的联合应用。结果 7例患者均取得满意的手术效果,无出血、胆瘘等并发症发生。手术时间130~330 min,平均(220±65)min,术中出血量20~600 mL,术后住院8~16 d,7例患者均治愈出院,且预后良好,随访半年至10年,期间无结石残留或复发。结论 胆肠吻合术后肝胆管再发结石患者的诊治应当始终坚持“取净结石、解除狭窄”的治疗原则,并对于不同部位再发结石的患者提供个性化及精准的手术方式。

Objective To explore the principle of surgical treatment of recurrent hepatolithiasis after cholangiojejunostomy.Methods Clinical data of 7 typical patients with recurrent hepatolithiasis after cholangiojejunostomy in Kunshan Hospital of Traditional Chinese Medicine between Jan.2006 and Dec.2022 were retrospectively analyzed.Location of recurrent stones of the 7 patients were all different.According to the location of recurrent stones and condition of intrahepatic and extrahepatic bile duct stenosis,personalized surgical methods were performed on the patients,including residual bile duct resection,choledochojejunostomy reconstruction,hepatic segmentectomy,hemihepatectomy and combined application of these surgical methods.Results Surgical results of all the 7 patients were satisfactory with no postoperative complications such as bleeding or biliary fistula.The average operative time was(220±65)min(range,130-330 min).Intraoperative bleeding volume ranged from 20 to 600 mL.Postoperative hospitalization time ranged from 8 to16 days.All the 7 patients were cured and discharged,with a good prognosis.There were no instances of residual or recurrent stones during the follow-up period of 6 months to 10 years.Conclusion Diagnosis and treatment of recurrent hepatolithiasis after cholangioenterostomy should be followed the concept“removing all stones and relieving stenosis”.Personalized and accurate surgical methods should be provided for patients according to the location of recurrent stones.