皮下通道型胆囊肝总管吻合术治疗区域性肝胆管结石27例报告

目的：为了解决传统胆肠内引流术在治疗区域性肝胆管结石中的诸多不足。方法：设计并应用了 一种新技术式以皮下通道型胆囊肝总管吻合术替代胆肠内引流术。在切除肝脏区域性结石病灶后， 切开肝总管约1．5cm，将胆囊壶腹部切开相应大小的切口与之吻合，并适当游离胆囊，使其底部可被固定于切口皮下，建立皮下胆囊与肝内外胆管间的吻合通道。结果：已完成该术式的27例患者，手术顺利，术后恢复良好，未发现并发症。1例患者于术后1年零9个月，肝内再次发现结石且伴胆道感染症状，急诊局麻下切开皮下胆囊通道行胆道镜取石，效果满意。结论：该术式简单、方便、易行，既能保存胆囊、胆管、Oddi括约肌及胃肠道的正常生理功能， 又为术后结石复发或残留提供了一治疗新途径，且避免了传统肠吻合术的不足，因而不治疗区域性肝胆管结石的较理想的方法。

Cholecysto-hepatoledochostomy plus construction of subcutaneous tunnel of the gallbladder in the treatment of regional hepatolithiasis.

Objective To overcome the faults of cholangio jejunostomy in the treatment of regional hepatolithiasis.Methods A novel operation was designed instead of cholangiojejunostomy.Common hepatic duct was cut open about 1.5cm in length after resection of regional hepatolithiasis.Furthermore,resected hartmanns pouch of the gallbladder was used to anastomose common hepatic duct while leaving the common bile duct and Oddis sphincter intact and fixing the fundus of the bladder subcutaneously.Results Twenty seven patients with regional hepatolithiasis underwent this operation sucessfully and recovered well without postoperative complications.Although 1 of 27 cases was again diagnosed as hepatolithiasis 1 year and 9 moths after operation,clinical effect was satisfactory by using this subcutaneous tunnel of the gallbladder.Conclusion This operation not only keeps the normal physical function of gallbladder,hepatic bile duct,Oddi sphincter intact and GI tract but also provides a new way to treat postoperative recurring or remaining stone.