Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China.
Can J Gastroenterol Hepatol. 2023 Jan 23;2023:5158580. doi: 10.1155/2023/5158580. eCollection 2023.
The surgical treatment of primary intrahepatic bile duct stones is associated with high rates of postoperative complications, stone recurrence, and reoperation. This study aimed to report an 11-year experience in the management of postoperative recurrence of intrahepatic bile duct stones, analyze the causes of the reoperation, and establish appropriate surgical procedures.
The records of 148 patients with postoperative recurrence of primary intrahepatic bile duct stones treated from January 2005 to December 2015 were retrospectively reviewed. Prior surgical treatment and postoperative data were analyzed to investigate possible causes of recurrence and reoperation.
All patients with a prior cholangiojejunostomy ( = 61) developed biliary stenosis (100%). Of the 86 patients without cholangiojejunostomy, 71 (82.56%) had abnormalities in the structure and function of the lower end of the common bile duct, and 86 had hilar and intrahepatic bile duct stenosis. Of all 148 patients, 136 (91.89%) had positive intraoperative bile cultures. Patients were treated with a modified surgical procedure, and the combined excellent and good rate of long-term outcomes reached 85.48% (106/124). The stone recurrence rate of the 124 patients decreased from 100% (124/124) of the prior operation to 5.65% (7/124) during the reoperation.
The pathogenesis of primary intrahepatic bile duct stones is associated with biliary infection and intrahepatic bile duct cholestasis. According to the etiology and pathogenic mechanism, surgical procedures that improve long-term outcomes and reduce postoperative recurrence include bile duct exploration with stone extraction, partial hepatectomy, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy.
原发性肝内胆管结石的手术治疗术后并发症、结石复发和再次手术的发生率较高。本研究旨在报告 11 年来处理肝内胆管结石术后复发的经验，分析再次手术的原因，并制定合适的手术方案。
回顾性分析 2005 年 1 月至 2015 年 12 月期间收治的 148 例原发性肝内胆管结石术后复发患者的病历资料。分析既往手术治疗及术后资料，探讨复发和再次手术的可能原因。
所有行胆肠吻合术的患者（ = 61）均发生胆管狭窄（100%）。86 例未行胆肠吻合术的患者中，71 例（82.56%）存在胆总管下段结构和功能异常，86 例存在肝门部及肝内胆管狭窄。所有 148 例患者术中胆汁培养均为阳性。患者采用改良手术治疗，长期疗效优良率达 85.48%（106/124）。124 例患者的结石复发率由术前的 100%（124/124）降至术后的 5.65%（7/124）。
原发性肝内胆管结石的发病机制与胆道感染和肝内胆汁淤积有关。根据病因和发病机制，改善长期疗效、减少术后复发的手术方案包括胆管探查取石、部分肝切除术、肝门胆管成形术和 Roux-en-Y 肝肠吻合术。
