A Retrospective Review of Surgical Treatment of Hepatolithiasis in 18 Years
- VernacularTitle:肝胆管结石的外科治疗——18年的回顾
- Author:
Zhiqiang HUANG
- Publication Type:Journal Article
- From:Journal of Third Military Medical University
1983;0(03):-
- CountryChina
- Language:Chinese
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Abstract:
Despite the recent improvement in the surgical treatment of hepatolithiasis, inadquate correction of the concommitant biliary tract stricture remains to be the major factor of therapeutic failure. Proper managements of both the stone and the stricture are two inseparable aspects of a problem. But today doctors are still in need of a series of effective operative procedures to accomplish this purpose.This paper is to report a retrospective study of 464 cases of hepatolithiasis surgically treated during a period from 1963 to 1981 in order to evaluate the different operative methods used in this institute on the basis of their long-term results. Internal entero-biliary drainage is considered as a major approach in the surgical treatment of hepatolithiasis. But the result of choledochoduodenostomy is far from satisfactory since it brings about a lot of serious sequalae, some of which are even disastrous. Many a patient requires opening of the anastomosis and is reoperated on according to the existed condition. It seems essential that the indication of choledochoduolienostomy should be restricted to a few carefully selected patients.To those late cases complicated with portal hypertension, staged operation has proved to be imperative. 11 out of the 14 late cases were saved since all of them underwent a meso-caval shunt before the operation on the hepatic lesion was performed. 2 of 3 deceased cases in this group were those without a preliminary shunt.The most difficult problem in the treatment of hepatolithiasis at present is the right lobe lesions especially those involving the second-order branches of hepatic duct. Several operative procedures the author used to manage this condition were introduced and discussed.
