一种治疗肝胆管结石和狭窄的术式——皮下通道型肝胆管成形术35例临床分析  

A approach for hepatolithiasis with bile duct strictures subcutaneous tunnel and hepatocholangioplasty with the use of gallbladder.

作　　者：田伏洲[1] 刘玮[1] 赵铁军[1] 胡建中[1] 苗建国[1] 李旭[1] 蔡忠红[1] 张丙印[1] 

机构地区：[1]成都军区总医院普外科

出　　处：《中国实用外科杂志》1998年第2期86-88,共3页Chinese Journal of Practical Surgery

摘　　要：对于肝胆管结石的治疗目前已取得了很多成功的经验，但最常使用的胆肠吻合术虽经不断改进，仍未能从根本上解决返流性胆管炎、胃肠分泌功能紊乱等并发症。为此，设计了一种新术式：即皮下通道型胆囊肝胆管成形术。在清除结石，解除肝内外胆管狭窄、肝门整形的基础上，利用胆囊壶腹部切开相应大小的切口与之吻合，并适当游离胆囊，使其底部可以被固定到切口皮下。患者必须具备基本正常的胆囊、肝外胆管和Ｏｄｄｉ括约肌。同时要求术中基本取尽肝内结石或切除病灶。已完成此手术共３５例，所有患者手术顺利，术后未发现并发症。其中１例３年后结石复发，１例２年后发生胆道蛔虫，均经皮下胆囊通道用胆道镜轻易取出。该术式既能处理好结石和狭窄问题，又能保存胆囊、胆管、Ｏｄｄｉ括约肌的功能，保持胃肠道的正常生理通路。Thirty five patients with hepatolithiasis and biliary stricture in porta hepatis underwent a new operation:subcutaneous tunnel and hepatocholangioplasty with the use of gallbladder(STHG).The strictured bile ducts in the hilus was opened after removal of stones or resection of the damaged liver segments.The gallbladder,instead of usually used jejunum,was anastomosed to the widely opened bile duct in the hilus to form a widened pass way through intrahepatic to extrahepatic ducts.The fundus of gallbladder was mobilized and pulled to abdminal wall to form a subcutaneous tunnel which could be used for re entry to liliary tree at any time,even many years later.The disadvantages of traditional choledochojejunostomy was avoided by the new operation.

关 键 词：胆管结石 胆管狭窄 肝胆管吻合术 皮下通道型 

分 类 号：R657.420.5[医药卫生—外科学] R657.460.5[医药卫生—临床医学]