Surgical Management of Recurrence of Primary Intrahepatic Bile Duct Stones.

IF 2.7 4区 医学 Q2 Medicine
HongTian Xia, HangYu Zhang, XianLei Xin, Bin Liang, Tao Yang, Yang Liu, Jing Wang, XiangFei Meng
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引用次数: 0

Abstract

Background: The surgical treatment of primary intrahepatic bile duct stones is associated with high rates of postoperative complications, stone recurrence, and reoperation. This study aimed to report an 11-year experience in the management of postoperative recurrence of intrahepatic bile duct stones, analyze the causes of the reoperation, and establish appropriate surgical procedures.

Materials and methods: The records of 148 patients with postoperative recurrence of primary intrahepatic bile duct stones treated from January 2005 to December 2015 were retrospectively reviewed. Prior surgical treatment and postoperative data were analyzed to investigate possible causes of recurrence and reoperation.

Results: All patients with a prior cholangiojejunostomy (n = 61) developed biliary stenosis (100%). Of the 86 patients without cholangiojejunostomy, 71 (82.56%) had abnormalities in the structure and function of the lower end of the common bile duct, and 86 had hilar and intrahepatic bile duct stenosis. Of all 148 patients, 136 (91.89%) had positive intraoperative bile cultures. Patients were treated with a modified surgical procedure, and the combined excellent and good rate of long-term outcomes reached 85.48% (106/124). The stone recurrence rate of the 124 patients decreased from 100% (124/124) of the prior operation to 5.65% (7/124) during the reoperation.

Conclusions: The pathogenesis of primary intrahepatic bile duct stones is associated with biliary infection and intrahepatic bile duct cholestasis. According to the etiology and pathogenic mechanism, surgical procedures that improve long-term outcomes and reduce postoperative recurrence include bile duct exploration with stone extraction, partial hepatectomy, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy.

原发性肝内胆管结石复发的外科治疗。
背景:原发性肝内胆管结石的手术治疗与术后并发症、结石复发和再手术的高发率有关。本研究旨在报告11年来处理肝内胆管结石术后复发的经验,分析再次手术的原因,建立合适的手术方法。材料与方法:回顾性分析2005年1月至2015年12月收治的148例原发性肝内胆管结石术后复发患者的资料。分析既往手术治疗及术后资料,探讨复发及再手术的可能原因。结果:所有既往行胆管空肠吻合术的患者(61例)均出现胆道狭窄(100%)。未行胆管空肠吻合术的86例患者中,总胆管下端结构及功能异常71例(82.56%),肝门及肝内胆管狭窄86例。148例患者中,136例(91.89%)术中胆汁培养阳性。采用改良手术方式治疗,远期疗效优良率达85.48%(106/124)。124例患者再次手术时结石复发率由术前100%(124/124)降至5.65%(7/124)。结论:原发性肝内胆管结石的发病机制与胆道感染和肝内胆管胆汁淤积有关。根据病因和发病机制,改善远期疗效和减少术后复发的手术包括胆管探查取石术、肝部分切除术、肝门管成形术和Roux-en-Y肝空肠吻合术。
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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