Fan S T, Mok F, Zheng S S, Lai E C, Lo C M, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Am J Surg. 1993 Mar;165(3):332-5. doi: 10.1016/s0002-9610(05)80837-2.
Hepaticocutaneous jejunostomy offers the advantage of permanent percutaneous access to the biliary tract in patients with complex biliary problems. The long-term value, however, has not been assessed. In 41 patients who underwent this procedure for intrahepatic stones, there was no hospital mortality, and the postoperative morbidity rate was 10%. The presence of the cutaneous stoma facilitated postoperative flexible choledochoscopy for dilatation of biliary strictures and extraction of residual stones. On follow-up, symptoms recurred in 12 patients (29%) at a median time of 27 months (range: 1 to 97 months). Reconstruction of the cutaneous stoma and flexible choledochoscopy via the jejunal loop helped to resolve the acute cholangitis (n = 4) and to eradicate recurrent stones in all cases. Hepaticocutaneous jejunostomy was also beneficial in the management of three patients who experienced further recurrence of symptoms. There was no major difficulty in reconstructing the cutaneous stoma and in performing choledochoscopy via the jejunal loop. The overall complication rate related to the cutaneous stoma was 15%. Repeat laparotomy for recurrent disease was required in only one patient who underwent a second bilio-enteric anastomosis for a nondilatable left duct stricture. We conclude that hepaticocutaneous jejunostomy is a valuable procedure in the management of hepatolithiasis.
肝皮空肠吻合术为患有复杂胆道问题的患者提供了经皮永久性进入胆道的优势。然而，其长期价值尚未得到评估。在41例因肝内结石接受该手术的患者中，无医院死亡病例，术后发病率为10%。皮肤造口的存在便于术后进行可弯曲胆管镜检查，以扩张胆管狭窄并取出残留结石。随访时，12例患者（29%）出现症状复发，中位时间为27个月（范围：1至97个月）。重建皮肤造口并通过空肠袢进行可弯曲胆管镜检查有助于解决急性胆管炎（n = 4），并在所有病例中根除复发性结石。肝皮空肠吻合术对另外3例症状进一步复发的患者的治疗也有益。重建皮肤造口和通过空肠袢进行胆管镜检查没有重大困难。与皮肤造口相关的总体并发症发生率为15%。仅1例因左肝管狭窄无法扩张而接受第二次胆肠吻合术的患者因疾病复发需要再次剖腹手术。我们得出结论，肝皮空肠吻合术是治疗肝内胆管结石的一种有价值的手术方法。
