Clinical Study Of Bile Duct Exploration And Bilioenterostomy In The Surgical Treatment Of Hepatolithiasis

Objective:To investigate the clinical effect of bile duct exploration and bilioenterostomy in the surgical treatment of hepatolithiasis.Methods:The clinical data of 89 cases of hepatolithiasis who were treated by surgical operation between October 2010 and November 2015 in our department were retrospectively analyzed, which were divided into bile duct exploration group and bilioenterostomy group whether there exists hilar bile duct stricture or not. The data as follows:general information, liver resection, calculi residual rate, postoperative complication rate and long-term efficacy was compared between two groups as well as the preoperative and postoperative cholangitis incidence of each group.Results: ①There were no significant difference in terms of gender ratio, age, weight, liver function symptoms and signs, blood biochemistry, calculus distribution, preoperative complications and the incidence of preoperative cholangitis between two groups (P> 0.05). ② There was no significant difference in the liver resection between two groups(P> 0.05).③It was comparable of calculi residual rate, postoperative complication rate and postoperative pathology(P> 0.05) between two groups.④The rate of preoperative cholangitis was not significantly different between two groups(P> 0.05); the preoperative cholangitis rate was higher than postoperative cholangitis rate in each group. As for postoperative follow-up, the rate of postoperative cholangitis in bilioenterostomy group was higher than that of bile duct exploration group (P=0.03).⑤The difference of calculi recurrence rate, incidence of bile duct stricture or anastomotic stenosis, canceration rate and mortality was not statistically significant (P>0.05).Conclusions: ①The operative methods of bile duct exploration and Roux-en-Y biliary-enteric anastomosis were all effective surgical treatment for hepatolithiasis, which is same about calculi residual rate, postoperative complication rate, calculi recurrence rate and canceration rate between two groups. Bile duct exploration is the preferred operation treatment for hepatolithiasis without hilar bile duct stricture, which ascribed to the retention of the Oddi sphincter function and low incidence of postoperative cholangitis.③Roux-en-Y biliary-enteric anastomosis in the treatment of hepatolithiasis with hilar bile duct stricture is exactly effective. With the abolition of Oddi sphincter function, the risk of reflux cholangitis increased after operation. For the above reasons, the application pointer of which should be strictly controlled.