Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2010 Jan 20;123(2):137-41.
Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis.
Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied.
The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45).
Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.
Oddi 括约肌在防止反流性胆管炎方面起着重要作用。在胆石症的治疗中，胆总管十二指肠吻合术的应用存在争议。本研究旨在评估胆总管十二指肠吻合术治疗胆石症的长期疗效。
回顾性分析 46 例胆石症患者行胆总管十二指肠吻合术的临床资料。比较术前和术后复发性胆管炎和急性胆管炎重型的发生率。采用配对卡方检验。
平均随访时间为 17.3 年（1.6-40 年），随访率为 97.8%（45/46）。本组患者残石率高（39.1%，18/46）、复发结石率高（31.1%，14/45）、未矫正狭窄率高（85%，17/20）、死亡率高（24.4%，11/45）。吻合口可见食物残渣和十二指肠内容物反流至胆道。复发性胆管炎的发生率与术前相同（93.3%，42/45）。胆总管十二指肠吻合术后急性胆管炎重型的发生率（46.7%，21/45）明显高于术前（20.0%，9/45）（P<0.01）。
胆总管十二指肠吻合术本身并不能完全达到清除结石、矫正狭窄和去除肝胆病变的目的。未经胆管成形术的胆总管十二指肠吻合术导致Oddi 括约肌抗反流功能丧失，加重严重反流性胆管炎。因此，胆总管十二指肠吻合术不是减少胆石症胆管炎的理想方法，也不是胆石症治疗的最佳选择。
