Internal anastomosis in the treatment of intrahepatic biliary calculi combined with strictured openings of biliary tracts
10.3760/cma.j.cn113855-20190911-00536
- VernacularTitle:内吻合在肝内胆管结石合并胆管口狭窄治疗中的应用
- Author:
Chuang PENG
1
;
Fu HUANG
;
Zengpeng SUN
;
Ou LI
;
Weimin YI
;
Jinshu WU
Author Information
1. 湖南师范大学附属第一医院(湖南省人民医院)肝胆外科 湖南省胆道疾病防治临床医疗技术研究中心，长沙 410005
- From:
Chinese Journal of General Surgery
2020;35(6):471-475
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the value of " internal anastomosis" of bile duct , ie intrahepatic duct stricture resection, cholangioplasty and bilioenteric anastomasis, in the treatment of hepatolithiasis with stricture of bile duct orifice.Methods:The clinical data of 74 patients undergoing this procedure from Dec 2017 to Dec 2019 at Hu′nan Provincial Peopole′s Hospital were retrospectively analysed.Results:All 74 patients received intraoperative choledochoscopy lithotomy, and 26 cases had a hepatectomy for atrophic fibrosis. There were 27 cases with orifice stricture of left-lateral bile duct or its major branchs; 22 cases with that of caudate lobe ducts. 3 cases with that of right anterior ducts; 8 cases with that of right posterior bileduct; and 14 cases with that of bilateral multiple bile ducts . The average operation time was (243±31) min (ranging from 180 to 360 min), the average intraoperative blood loss was (150±26) ml (ranging from 100 to 600 ml). The average postoperative hospital stay was (10.0±2.2) d. The occurrence rate of residual stone was 8.1%. 14 cases (18.9%) had postoperative complications , including 2 cases with bleeding, 1 case with bile leakage, 4 cases with wound infection, 13 cases with pleural effusion. All were cured by conservative therapy, and no complications of grading Ⅲa or above happened according to Clavien Dindo grading system. All 74 cases were followed up, the average follow-up time was (10.2±3.6) months (ranging from 6 to 18months) with good result.Conclusion:" internal anastomosis" is an effective method to remove the narrow openings of intrahepatic bile ducts , thus helps to preserve much possible liver parenchyma, while decreasing the rate of residual stone.
