胆肠吻合术在治疗肝胆管结石中的作用

目的探讨胆肠吻合术在治疗肝胆管结石中的指征和作用。方法回顾分析我院314例不伴有胆管狭窄或囊性病变的肝胆管结石,比较不同胆道引流下的残石率和手术疗效。结果全组无手术死亡,住院死亡率为16%。胆肠吻合组和T管引流组术后残石率无差异,但经胆道镜取石后,T管组术后总的残石率显著低于胆肠吻合组(05%vs175%,P<001)。肝切除 T管引流术后胆管炎发生率为82%,显著低于肝切除 胆肠吻合术。胆肠吻合组手术时间明显延长,手术并发症高于T管引流组。结论肝切除术 术中或术后胆道镜取石是治疗肝胆管结石最有效的方法。只有同时合并胆道狭窄或囊性扩张的病例,由于要切除病变的胆管,才必须行胆肠吻合术重建胆道引流。

Role of choledochojejunostomy in the treatment of intrahepatic lithiasis

Objective To evaluate the surgical indications and efficacy of choledochojejunostomy for the treatment of intrahepatic lithiasis. Methods The clinical data of 314 patients with intrahepatic lithiasis but without biliary stricture and cystic dilatation treated in our hospital in the past 10 years were retrospectively analyzed. The rate of residual stone and surgical efficacy were compared among different biliary drainage procedures. Results There was no surgical mortality. The total hospital mortality was 1.6%. There was no statistical difference between choledochojejunostomy group and T-tube drainage group in terms of residual stone rate. However, after postoperative choledochoendoscopic stone extraction, the total rate of residual stone was significantly lower in the T-tube drainage group than in the choledochojejunostomy group (0.5% vs 17.5%, P<0.01). Hepatectomy T-tube drainage achieved the optimal therapeutic effect and only 8.2% of the patients suffered from attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy choledochojejunostomy. The operative duration and morbidity were markedly higher in the patients undergoing choledochojejunostomy than in those receiving T-tube drainage. Conclusions Hepatectomy followed by intraoperative or postoperative choledochoendoscopic stone extraction is the optimal management for the intrahepatic lithiasis. Choledochojejunostomy for bile duct reconstruction is only necessary for the patients with biliary stricture and cystic dilatation because the impaired bile duct should be resected.