| Background and Aim Hepatolithiasis is not only a common disease, but also a benign disease without trend of spontaneous cure. Because of the high incidence rate of complication, the high recurrence rate of hepatolithiasis, as well as the high rate of reoperation, how to cure the patients with hepatolithiasis become an arduous task in the field of biliary tract surgery. Professor Fuzhou Tian devised and performed a new operation: subcutaneous tunnel and hepatocholangioplasty using gallbladder(STHG). The strictured bile ducts in the hilus were 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 way from intrahepatic to extrahepatic ducts. The fundus of gallbladder was mobilized and pulled to abdominal wall to form a subcutaneous tunnel which could be used for re-entry to biliary tree at any time. The disadvantages of traditional choledochojejunostomy were avoided by the new operation. More than ninety patients with hepatolithiasis had undergone the new operation from Dec. 1994 to Nov.2000. The curative effect was satisfactory. It has been proved that the mobile function of the gallbladder was normal following the STHG, however, further clinical and experimental studies should be carried out, such as the incidence rate of cholangitis, the recurrence rate of hepatolithiasis, the changes of bile component, healing process of the Hepaticocholedocho-stoma following STHG. Those problems were discussed in this study, so that the experimental basis for the clinical therapy for hepatolithiasis could be offered. Methods1. To observe the incidence rate of cholangitis and the recurrence rate of hepatolithiasis, the patients with hepatolithiasis cured by STGH or subcutaneous blindloop and cholangio-jejunostomy (SLCJ) from 1994 to 2000were followed up.2. 29 dogs were divided randomly into two groups: control group(5 dogs) and model(stenosis of left hepatic duct) group(24 dogs). The 24 dogs in model group were divided randomly into four groups: 1 month after hepaticocholedochostomy (HC) group(5 dogs), 5 month after HC group(6 dogs), 1 month after hepaticojejunostomy(HJ) group (5 dogs) and 5 month after HJ group (4 dogs). At the end of the experiment, the bile was withdrown from the bile duct and the bile duct tissue was removed. The bile components such as Ca++, unconjugated bilirubin(UCB), mucin, superoxide dismutase (SOD), lateral preoptic(LPO) were mensurated. Histopathological changes in the bile duct were observed with HE staining. The expression of α-smooth muscle actin((-SMA) in bile duct tissue was observed with immunohistochemical SP staining. The expression of collagen-â… mRNA in bile duct tissue was observed with semi-quantified RT-PCR.Main Results1. During the 5 years, 134 patients were followed up for an average of 4 years and 2 months. For STHG and SLCJ group, the postoperative incidence rate of cholangitis was 6.1%(3/49) and 21.2%(18/85) respectively; the recurrence rate of hepatolithiasis was 4.1%(2/49) and 17.6%(15/85) respectively. The postoperative incidence rate of cholangitis and the recurrence rate of hepatolithiasis were both lower significantly in STHG group compared with SLCJ group. The factors associated with formation of hepatolithiasis in the two groups, such as age, gender, the ratio of patients with lobectomy of liver, the type of hepatolithiasis, stenosis of bile duct, jaundice happened before the surgery and dystrophia, had no significant difference between STHG and SLCJ group.2. Hepaticocholedochostomy used shorter time and lost less blood than hepaticojejunostomy. The dogs with hepaticocholedochostomy lost less weight than the dogs with hepaticojejunostomy. For HC and HJ groups, the mortality rate was 1/12 and 3/12; the infectious rate of incision was 3/12 and 5/12 respectively.3. Serum levels of total bilirubin and transaminase increased significantly on the 7th week after stenosis of left hepatic duct compared... |
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