Anderberg B, Bolin S, Heuman R, Sjödahl R
Acta Chir Scand. 1984;150(1):75-8.
Choledochoduodenostomy in the prevention and treatment of patients with common bile duct stones has been frequently discussed during several years. The introduction of endoscopic sphincterotomy, with excellent results and low morbidity necessitate further examination of the indications for and the value of this procedure as an adjunct to choledocholithotomy. Twenty patients with a mean age of 73 years have been operated on with choledocholithotomy and subsequent choledochoduodenostomy. In 7 of the patients the anastomosis was performed at a primary operation, in 11 at a secondary and in 2 at a third operation. Seven of the patients had primary bile duct stones, while thirteen had multiple stones, either unextractable or with a doubtful clearance. There was no postoperative mortality and only one early complication, a pneumonia. Eighteen of the 20 patients are free of symptoms postoperatively and have normal liver function tests and verified open anastomoses. Two patients had recurrent postoperative cholangitis, one due to a stricture in the anastomosis, which was reoperated, and one due to multiple retained stones intrahepatically despite an open anastomosis. In conclusion choledochoduodenostomy is easy to perform with low morbidity even in old-aged, high-risk patients. It is a safe and effective method in the prevention of retained or recurrent stones.
胆总管十二指肠吻合术在胆总管结石患者的预防和治疗中已被讨论多年。内镜括约肌切开术的引入，效果良好且发病率低，这就需要进一步研究该手术作为胆总管切开取石术辅助手段的适应证和价值。20例平均年龄为73岁的患者接受了胆总管切开取石术及随后的胆总管十二指肠吻合术。其中7例患者在初次手术时进行了吻合，11例在二次手术时进行，2例在三次手术时进行。7例患者有原发性胆管结石，13例有多发结石，要么无法取出，要么结石清除情况存疑。术后无死亡病例，仅1例早期并发症，即肺炎。20例患者中有18例术后无症状，肝功能检查正常，吻合口通畅得到证实。2例患者术后发生复发性胆管炎，1例是由于吻合口狭窄，进行了再次手术；另1例尽管吻合口通畅，但肝内仍有多发残留结石。总之，胆总管十二指肠吻合术操作简便，即使在老年高危患者中发病率也低。它是预防残留或复发性结石的一种安全有效的方法。
