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, 張永杰.對膽腸吻合術治療肝膽管結石的幾點認識[J].肝膽胰外科雜志, 2011, 23(3):187-189.
12.	劉永雄.膽道結石(特別是肝膽管結石)手術治療的遠期療效——一篇塵封三十二年的專業學術資料[J].中華肝膽外科雜志, 2011, 17(2):83-87.
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1. ?中華醫學會外科學分會膽道外科學組.肝膽管結石病診斷治療指南[J].中華消化外科雜志, 2007, 6(2):156-161.
2. 劉付寶, 耿小平.膽腸內引流術在肝內膽管結石中的應用[J].肝膽外科雜志, 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. 黃志強.當代膽道外科學[M].上海:上海科學技術文獻出版社, 1998:409-410.
5. 趙義軍, 劉付寶, 趙紅川, 等.《康恒醫療隨訪管理系統》在肝癌隨訪中的應用體會[J].肝膽外科雜志, 2013, 21(4):294-295.
6. 閆勇, 戴睿武, 田伏洲.皮下盲襻型膽管空腸吻合術在肝膽管結石治療中的應用(附2100例報告)[J].四川醫學, 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.肝內膽管結石外科治療中的問題[J].肝膽外科雜志, 2010, 18(2):81-82.
11. 史嵩, 張永杰.對膽腸吻合術治療肝膽管結石的幾點認識[J].肝膽胰外科雜志, 2011, 23(3):187-189.
12. 劉永雄.膽道結石(特別是肝膽管結石)手術治療的遠期療效——一篇塵封三十二年的專業學術資料[J].中華肝膽外科雜志, 2011, 17(2):83-87.
13. 黃靜, 陸才德, 吳勝東, 等.不合理的膽腸內引流及支架植入術后再手術分析[J].中華肝膽外科雜志, 2013, 1(4):255-258.
14. 劉付寶, 王國斌, 羅毅釗, 等.精準肝臟外科理念在肝膽管結石病治療中的臨床價值[J].中華消化外科雜志, 2014, 13(6):447-451.
15. 劉付寶, 毛長坤, 張志功, 等.肝內膽管結石圍手術期的快速康復治療[J].中國普通外科雜志, 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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