Ker C G, Kuo K K, Tsai C C, Chen J S, Lee K T, Sheen P C
Department of Surgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Int Surg. 1994 Apr-Jun;79(2):110-3.
Twenty-nine patients, 16 males and 13 females, with intrahepatic stones were treated by choledochojejunostomy with subcutaneous jejunostomy after choledocholithotomy in cases where the common bile duct was dilated more than 2 cm in diameter. This surgical technique consists of putting a segment of jejunum in the subcutaneous area with a jejunostomy after finishing the choledochojejunostomy. If the stone recurs years later, this loop of jejunum will offer a route for inserting the scope while producing the fistulotomy under local anesthesia. These patients became symptomless soon after removal of the residual stone by postoperative choledochoscope. After more than five years of follow-up study, seven cases (24.1%) had reflux cholangitis and among them, four patients had recurrent stones. Reopening of the fistulotomy was carried out under local anesthesia, and the choledochoscope was inserted into the bile duct through the jejunum for removal of those recurrent stones. We believe that this surgical technique is very effective for the treatment of patients with recurrent intrahepatic stones without the necessity of major laparotomy.
29例肝内胆管结石患者，男性16例，女性13例，在胆总管直径扩张超过2cm的情况下，于胆总管切开取石术后行胆总管空肠吻合术并皮下空肠造口术。该手术技术包括在完成胆总管空肠吻合术后，通过空肠造口将一段空肠置于皮下区域。如果数年后结石复发，这段空肠将为在局部麻醉下进行瘘管切开术时插入内镜提供一条途径。术后通过胆道镜取出残留结石后，这些患者很快症状消失。经过五年多的随访研究，7例（24.1%）发生反流性胆管炎，其中4例患者有结石复发。在局部麻醉下再次行瘘管切开术，通过空肠将胆道镜插入胆管以取出那些复发结石。我们认为，这种手术技术对于治疗复发性肝内胆管结石患者非常有效，无需进行大型剖腹手术。
