Yamamoto H, Nimura Y, Hayakawa N, Kamiya J, Shionoya S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1990 Nov;91(11):1715-9.
From January 1976 through December 1988 we encountered ninety nine cases of intrahepatic stones. Eight of them were complicated with postoperative bile duct strictures which were formed on cholangiojejunostomy in 5 cases, cholangioduodenostomy, hepatic hilum and common hepatic duct in 1 case, respectively. Six cases of them are anastomotic strictures. The stones were mainly composed of bilirubin calcium. We guessed that the bile duct stricture resulted from cholangiojejunostomy without Roux-en-Y in 1 case and anastomotic insufficiency in 5 cases. Intrahepatic stones were removed by percutaneous transhepatic cholangioscopy (PTCS), and the treatment for the stricture was cholangiojejunostomy in 1 case and the dilatation by PTCS in 5 cases, including 3 endoprostheses by pig-tail silicone catheter and 2 internal-external biliary drainage. Two patients who did not undergo cholangioscopic dilatation died of sepsis due to cholangitis. Three of 5 patients who underwent endoscopic dilatation by PTCS could return to social life without recurrence of gallstones. In other two cases an endoprosthetic catheter was removed by PTCS because of dislodgement or obstruction of the catheter after confirming anastomotic strictures had improved. Authors recommended that PTCS should be applied for postoperative bile duct stricture complicated with intrahepatic stone.
1976年1月至1988年12月期间，我们共收治99例肝内胆管结石患者。其中8例合并术后胆管狭窄，5例发生于胆管空肠吻合术后，1例分别发生于胆管十二指肠吻合术、肝门部及肝总管。6例为吻合口狭窄。结石主要成分为胆红素钙。我们推测1例胆管狭窄是由于未行Roux-en-Y的胆管空肠吻合术所致，5例是由于吻合口功能不全。通过经皮经肝胆道镜检查（PTCS）取出肝内结石，1例胆管狭窄采用胆管空肠吻合术治疗，5例采用PTCS扩张治疗，其中3例置入猪尾硅胶导管内支架，2例采用内外胆管引流。2例未接受胆道镜扩张治疗的患者死于胆管炎败血症。5例接受PTCS内镜扩张治疗的患者中有3例恢复正常社会生活，未复发胆结石。另外2例在确认吻合口狭窄改善后，因导管移位或阻塞，通过PTCS取出内支架导管。作者建议PTCS应用于合并肝内结石的术后胆管狭窄。
