Li Xu, Shi Li, Wang Yu, Tian Fu-Zhou
Department of General Surgery, Chengdu Military General Hospital, Chengdu 610083, China.
Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):597-9.
Roux-en-Y choledochojejunostomy is routinely performed in patients with regional hepatolithiasis. However, some of these patients, who have a normal gallbladder and normal Oddi's sphincter, are unnecessarily undergoing bilio-intestinal drainage. Alternatively, reconstruction can be achieved by subcutaneous tunnel and hepatocholangioplasty with the utilization of the gallbladder (STHG). This method is effective to potential endoscopic tunnel and intervention during follow-up, and prevention of reflux cholangitis as well as the disorders of the GI tract.
The middle and long-term complications of 46 patients who underwent STHG were analyzed. With B-ultrasonography and biochemical assay, the contraction and concentration function of the gallbladder were also studied.
Follow-up showed that all patients survived with a relatively normal life. One patient experienced right epigastric pain, chills and fever because of a stone which impacted in the left hepatic bile duct. Another patient had cholangitis because of biliary ascariasis. The two patients were treated by endoscopic therapy within the subcutaneous gallbladder under local anesthesia.
This operation not only keeps the normal physical functional of the gallbladder, Oddi's sphincter and gastrointestinal tract, but also prevents reflux cholangitis and the disorder of the digestive tract. Hence STHG is a novel operation dealing with regional hepatolithiasis.
对于肝内胆管结石患者，常规施行 Roux-en-Y 胆总管空肠吻合术。然而，部分胆囊及奥迪括约肌功能正常的患者接受胆肠内引流术是不必要的。另外，利用胆囊经皮下隧道行肝内胆管成形术（STHG）可实现重建。该方法对后续潜在的内镜下隧道及干预、预防反流性胆管炎以及胃肠道紊乱均有效。
分析 46 例行 STHG 患者的中长期并发症。通过 B 超及生化检测，研究胆囊的收缩及浓缩功能。
随访显示所有患者均存活，生活相对正常。1 例患者因结石嵌顿于左肝管出现上腹部右侧疼痛、寒战及发热。另 1 例患者因胆道蛔虫病发生胆管炎。这 2 例患者在局部麻醉下经皮下胆囊行内镜治疗。
该手术不仅保留了胆囊、奥迪括约肌及胃肠道的正常生理功能，还预防了反流性胆管炎及消化道紊乱。因此，STHG 是一种治疗肝内胆管结石的新术式。
