两种肝门整形胆道重建术后胆管炎发生和结石复发的对比

目的　评价皮下通道型胆囊肝胆管成形术 (STGH)与皮下盲袢型肝胆管空肠吻合术(SLCJ)的远期疗效。方法　随访本中心 6年间因肝胆管结石接受这两种手术方式的治愈患者 ,观察他们的胆管炎发生和结石复发的情况。结果　 198例研究对象共有 14 8例获得随访 ,平均随访时间 3年 11个月。两组间部分可能引起胆管炎、胆管结石复发的因素差异均无统计学意义。STHG组与SLCJ组术后胆管炎发生率分别为 5 4 %和 2 1 7% (P <0 0 5 ) ,胆管结石复发率分别为 3.6 %和 17 4% (P <0 0 5 )。结论　STHG组术后远期疗效优于SLCJ组。原因可能是STHG术后保留了Oddi括约肌且在胆囊与肝胆管之间建立了一个宽畅通道 ,防止了胆肠返流的发生 ,发挥了胆囊的浓缩、吸收和排空功能。因此 ,对于胆囊和Oddi括约肌功能基本正常的肝胆管结石患者应该考虑行STHG术。

Comparison of post-operative morbidity of cholangitis and recurring rate of hepatolithiasis between STHG and SLCJ

Objective To evaluate the long term effects of subcutaneous tunnel and hepatocholangioplasty with the use of gallbladder (STHG) and subcutaneous blindloop cholangio jejunostomy (SLCJ). Methods The patients with hepatolithiasis treated by STHG or SLCJ between Dec. 1994 and Nov. 2000 in our hospital were followed up to determine the post operative morbidity of cholangitis and recurring rate of hepatolithiasis. Results During the 6 years 148 patients were followed up for an average of 3 years and 11 months. The postoperative morbidity of cholangitis was 5 4% (3/56) and 21 7% (20/92) and recurring rate of hepatolithiasis 3 6% (2/56) and 17 4% (16/92) in STHG group and SLCJ group, respectively. There were significant differences between the 2 groups. Such factors related to formation of hepatolithiasis as the age, gender, ratio of patients with lobectomy of liver, type of hepatolithiasis, stenosis of bile, jaundice happening before the operation and dystrophia etc. were not significantly different between the 2 groups. Conclusions Patients undergoing STHG have the better outcome. The main cause for which is that the function of Oddi's sphincter is maintained and the spacious tunnel is built between gallbladder and bile duct so that the function of gallbladder such as concentration, absorption and emptying etc. can be normal. Therefore, STHG should be the better choice for the patients with normal gallbladder and Oddi's sphincter.