Li Shao-Qiang, Liang Li-Jian, Peng Bao-Gang, Lai Jia-Ming, Lu Ming-De, Li Dong-Ming
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yet-san University, Guangzhou 510080, Guangdong Province, China.
World J Gastroenterol. 2006 Jul 14;12(26):4170-4. doi: 10.3748/wjg.v12.i26.4170.
To evaluate the long-term outcome and surgical indications of hepaticojejunostomy (HJ) for the treatment of hepatolithiasis.
Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A(1): hepatectomy+HJ; group A(2): choledochoctomy+HJ; group B(1): hepatectomy + choledochoctomy T tube drainage; group B(2): choledochoctomy + T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures.
There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group (0.5% vs 16.7%, P < 0.01). Hepatectomy + choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy + HJ (8.2% vs 22.0%, P = 0.034). The major reason for postoperative cholangitis was stone residual in the HJ group (16/23, 70.0%), and stone recurrence in the T tube drainage group (34/35, 97.1%). The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage.
The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangitis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.
评估肝空肠吻合术（HJ）治疗肝内胆管结石的长期疗效及手术指征。
回顾性分析过去10年收治的314例择期肝内胆管结石患者，这些患者无胆管狭窄或胆囊扩张。根据胆管引流方式将患者分为HJ组和T管引流组。此外，以肝切除术作为平衡因素再分为四个亚组，A（1）组：肝切除术+HJ；A（2）组：胆总管切除术+HJ；B（1）组：肝切除术+胆总管切除术T管引流；B（2）组：胆总管切除术+T管引流。比较不同术式的结石残留率、手术疗效及长期疗效。
所有患者均无手术死亡。总住院死亡率为1.6%。手术清除后总体结石残留率为25.9%。手术清除后HJ组和T管引流组的结石残留率无统计学差异，然而，术后经胆道镜碎石后，T管引流组的总结石残留率显著低于HJ组（0.5%对16.7%，P<0.01）。肝切除术+胆总管切除T管引流取得了最佳治疗效果，仅8.2%的患者术后发生胆管炎，显著低于肝切除术+HJ组（8.2%对22.0%，P=0.034）。HJ组术后胆管炎的主要原因是结石残留（16/23，70.0%），T管引流组是结石复发（34/35，97.1%）。接受HJ的患者手术时间显著延长，HJ的手术并发症发生率高于T管引流。
在这项回顾性研究中，由于结石残留率高和术后胆管炎，HJ治疗肝内胆管结石的效果不理想。HJ不能有效引流残留结石。HJ可能会阻碍术后胆道镜碎石，而术后胆道镜碎石是治疗术后残留结石的最佳方法。肝内胆管结石HJ的手术指征应严格选择。
