Option of Biliary Drainage for Surgical Management of Hepatolithias_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENZhi-heng , LIUFu-bao , WANGGuo-bing , ZHAOYi-jun , ZHAOHong-chuan , XIEKun , HUANGFan , YUXiao-jun ,  GengXiao-ping

Centre of Organ Transplantation, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China;

Corresponding author：

GengXiao-ping, Email: xp-geng@126.net

Keywords：

Hepatolithiasis; Sphincter of Oddi function; Biliary enteric drainage

DOI：

10.7507/1007-9424.20140334

Video：

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Objective To investigate the option of biliary drainage for surgical management of hepatolithias. Methods The clinical data of 146 patients with hepatolithiasis, who were admitted to the First Affiliated Hospital of Anhui Medical University from March 2006 to June 2014, was analyzed retrospectively.These patients were divided into biliary enteric drainage group and T tube drainage group according to the function of sphincter of Oddis.The intra-operative related data, postoperative complications, and long-term efficacy were compared between two groups. Results ①The two groups were comparable in terms of gender, age, body weight, preoperative liver function, preoperative symp-toms and signs, preoperative biochemical index, calculus distribution, preoperative complications (P > 0.05).②There were no significant differences of the hepatolobectomy rate, intraoperative blood loss, intraoperative blood transfusion, times and time of hepatic portal occlusion, bile culture positive rate, hospital stay and hospitalization expenses between two groups (P > 0.05).But the operation time of the biliary enteric drainage group was significantly longer than that of the T tube drainage group (P < 0.001).③The total complications rate and specific complication rate were not signifi-cantly different between two groups (P > 0.05).④The stone instant clearance rate of the biliary enteric drainage group was significantly higher than that of the T tube drainage group (P=0.031).But the stone final clearance rate was not significantly different between two groups (P=0.841).⑤The postoperative quality of life was not significantly different between two groups (Excellent and good:P=0.560;Poor:P=0.560).The rates of stone residual, recurrence, mortality and canceration were not significantly different between two groups (P > 0.05). Conclusion The biliary drainage for surgical management of hepatolithias is selected according to the function of sphincter of Oddi.Biliary enteric drainage and Roux-en-Y anastomosis are firstly selected for patients with the loss of function of sphincter of Oddi.

Citation： CHENZhi-heng, LIUFu-bao, WANGGuo-bing, ZHAOYi-jun, ZHAOHong-chuan, XIEKun, HUANGFan, YUXiao-jun, GengXiao-ping. Option of Biliary Drainage for Surgical Management of Hepatolithias. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(11): 1401-1407. doi: 10.7507/1007-9424.20140334 Copy

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11.	史嵩, 张永杰.对胆肠吻合术治疗肝胆管结石的几点认识[J].肝胆胰外科杂志, 2011, 23(3):187-189.
12.	刘永雄.胆道结石(特别是肝胆管结石)手术治疗的远期疗效——一篇尘封三十二年的专业学术资料[J].中华肝胆外科杂志, 2011, 17(2):83-87.
13.	黄静, 陆才德, 吴胜东, 等.不合理的胆肠内引流及支架植入术后再手术分析[J].中华肝胆外科杂志, 2013, 1(4):255-258.
14.	刘付宝, 王国斌, 罗毅钊, 等.精准肝脏外科理念在肝胆管结石病治疗中的临床价值[J].中华消化外科杂志, 2014, 13(6):447-451.
15.	刘付宝, 毛长坤, 张志功, 等.肝内胆管结石围手术期的快速康复治疗[J].中国普通外科杂志, 2013, 22(8):1033-1037.
16.	Tocchi A, Mazzoni G, Liotta G, et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1000 patients[J].Ann Surg, 2001, 234(2):210-214.

1. 中华医学会外科学分会胆道外科学组.肝胆管结石病诊断治疗指南[J].中华消化外科杂志, 2007, 6(2):156-161.
2. 刘付宝, 耿小平.胆肠内引流术在肝内胆管结石中的应用[J].肝胆外科杂志, 2013, 21(2):145-146.
3. Lee TY, Chen YL, Chang HC, et al.Outcomes of hepatectomy for hepatolithiasis[J].World J Surg, 2007, 31(3):479-482.
4. 黄志强.当代胆道外科学[M].上海:上海科学技术文献出版社, 1998:409-410.
5. 赵义军, 刘付宝, 赵红川, 等.《康恒医疗随访管理系统》在肝癌随访中的应用体会[J].肝胆外科杂志, 2013, 21(4):294-295.
6. 闫勇, 戴睿武, 田伏洲.皮下盲襻型胆管空肠吻合术在肝胆管结石治疗中的应用(附2100例报告)[J].四川医学, 2010, 31(9):1248-1250.
7. Kuo KK, Utsunomiya N, Nabae T, et al.Sphincter of Oddi motility in patients with hepatolithiasis and common bile duct stones[J].Dig Dis Sci, 2000, 45(9):1714-1718.
8. Shah OJ, Robbani I, Shah P, et al.Left-sided hepatic resection for hepatolithiasis:a longitudinal study of 110 patients[J].HPB (Oxford), 2012, 14(11):764-771.
9. Liang TB, Liu Y, Bai XL, et al.Sphincter of Oddi laxity:an important factor in hepatolithiasis[J].World J Gastroenterol, 2010, 16(8):1014-1018.
10. 耿小平.肝内胆管结石外科治疗中的问题[J].肝胆外科杂志, 2010, 18(2):81-82.
11. 史嵩, 张永杰.对胆肠吻合术治疗肝胆管结石的几点认识[J].肝胆胰外科杂志, 2011, 23(3):187-189.
12. 刘永雄.胆道结石(特别是肝胆管结石)手术治疗的远期疗效——一篇尘封三十二年的专业学术资料[J].中华肝胆外科杂志, 2011, 17(2):83-87.
13. 黄静, 陆才德, 吴胜东, 等.不合理的胆肠内引流及支架植入术后再手术分析[J].中华肝胆外科杂志, 2013, 1(4):255-258.
14. 刘付宝, 王国斌, 罗毅钊, 等.精准肝脏外科理念在肝胆管结石病治疗中的临床价值[J].中华消化外科杂志, 2014, 13(6):447-451.
15. 刘付宝, 毛长坤, 张志功, 等.肝内胆管结石围手术期的快速康复治疗[J].中国普通外科杂志, 2013, 22(8):1033-1037.
16. Tocchi A, Mazzoni G, Liotta G, et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1000 patients[J].Ann Surg, 2001, 234(2):210-214.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Option of Biliary Drainage for Surgical Management of Hepatolithias

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