[The prevention of hepatolithiasis and biliary stricture post choledochojejunostomy].
OBJECTIVE
To investigate the prevention of hepatolithiasis and biliary stricture post choledochojejunostomy using choledochoscopy technique and evaluate feasibility and efficacy of choledochojejunostomy and artificial valve of efferent loop in preventing reflux.


METHODS
To analyze the data of 47 patients with hepatolithiasis who had been operated with Roux-en-Y cholangiojejunostomy and artificial valve of efferent loop to prevent bilio-intestinal regurgitation. Of the patients, 19 were marked with silver nip at the jejunum export of bilio-intestinal anastomosis. The regurgitation, recurrence, anastomotic stricture and their managements after the surgery were investigated.


RESULTS
The bilio-intestinal regurgitation were found in 32 cases (32/47, 68.1%), it suggested that artificial valve could not prevent bilio-intestinal regurgitation efficiently. Two cases of hepatolithiasis recurred and were cured by sinus tract placement with the aid of silver nip mark under choledochoscope instead of re-operation. Of the 6 cases with anastomotic stricture, 5 cases were treated successfully with stone extraction, biliary stent dilatation under the percutaneous transhepatic cholangioscopy (PTCS) and the other one case died.


CONCLUSIONS
Silver nip mark provides safe and simple path for the cholangioscopy, it made the treatment of the recurrent biliary stricture and stone safe and brief, made the cholangioscopy play more important role in the hepatolithiasis, residual stone and biliary stricture. PTCS is mini-invasive, safe, simple and effective.
Yang
Yu-long
YL
Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery, Dalian Friendship Hospital, Dalian 116001, China. yyl516@126.com
Tan
Wen-xiang
WX
Feng
Zhong-yi
ZY
Fu
Wei-li
WL
Guo
Hong-wei
HW
Lang
Gui-ling
GL
Xi
Li-gang
LG
Wang
Xiao-guang
XG
Mao
Wei
W
Lü
Wen-cai
WC
Wang
Xiao-liang
XL
Wu
Shuo-dong
SD
Yu
Hong
H
Tian
Zhong
Z
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001653:Bile Ducts, Intrahepatic; D002769:Cholelithiasis / Q000517:prevention & control / Q000601:surgery*; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome