肝胆管结石病人皮下永久性胆管通路建立及其应用价值分析

目的 总结在肝胆管结石外科治疗中建立皮下永久性胆管通路的方法及临床价值。方法 回顾性分析1984年12月至2008年12月成都军区总医院全军普通外科中心收治的2278例肝胆管结石病人的临床资料。均通过外科手术治疗并在术中设置了皮下永久性胆管通路。对128例区域性肝胆管结石病人采用皮下通道型胆囊肝总管吻合建立皮下永久性胆管通路。结果 2278例病人中，获随访792例。随访中，胆管结石复发者184例（占23.2%），均施行了皮下胆管通路切开、胆道镜取石术。其中，切开皮下空肠袢175例，切开皮下胆囊9例。对于同时伴有吻合口狭窄的43例病人，在胆道镜下采用胆道气囊进行扩张，狭窄得到了不同程度的纠正。全部病人均病愈出院。结论 在肝胆管结石病人手术中，建立皮下永久性胆管通路是治疗术后复发结石的重要步骤。对于区域性肝胆管结石病人，术中利用胆囊建立皮下永久性胆管通路不失为简单、可靠的方法。

Estabolishment of subcutaneous permanent tunnel to bile duct and its role on the treatment of patients with hepatolithiasis

Estabolishment of subcutaneous permanent tunnel to bile duct and its role on the treatment of patients with hepatolithiasis TANG Li-jun, TIAN Fu-zhou, CUI Jian-feng, et al. Center of General Surgery, Chengdu General Hospital of PLA Chengdu Command, Chengdu 610083, China Corresponding author: TANG Li-jun, E-mail：whjtlj@yahoo.com.cn Abstract Objective To sum up the methods and clinical values to construct a subcutaneous permanent tunnel to bile duct during surgical treatment of hepatolithiasis. Methods A retrospective analysis was carried out on clinical data of 2,278 patients with hepatolithiasis, admitted from Dec. 1984 to Dec. 2008 by the Center of General Surgery, Chengdu General Hospital of PLA Chengdu Command. All patients received a surgical operation, and a subcutaneous permanent tunnel to bile duct was constructed in each patient during the surgery. Of those patients, the subcutaneous permanent tunnel to bile duct was constructed through cholecysto-hepatoledochostomy in 128 patients with regional hepatolithiasis. Results Of the 2278 patients, 792 patients were followed up. During the follow-up, 184 patients (making up of 23.23%) with recurrent bile duct stone received incision of subcutaneous tunnel and stone removal by choledochoscopy. Of them, 175 patients received incision of subcutaneous jejunal loop, and 9 patients received that of subcutaneous gallbladder. The 43 patients concurrently complicated with anastomotic stenosis received expansion with biliary balloon under choledochoscopy, and such stenosis were corrected to different extents. All patients were recovered and discharged out of the hospital. Conclusion During surgery of patients with hepatolithiasis, it is a key procedure for treatment of post-surgical recurrent stone to construct a subcutaneous permanent tunnel to bile duct. For patients with regional hepatolithiasis, it may still be a simple and reliable method to construct a subcutaneous permanent tunnel to bile duct via gallbladder.