title: [The prevention of hepatolithiasis and biliary stricture post choledochojejunostomy].
abstract: 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.
authors.affiliation: Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery, Dalian Friendship Hospital, Dalian 116001, China. yyl516@126.com
authors.forename: Yu-long
authors.initials: YL
authors.lastname: Yang
authors.forename: Wen-xiang
authors.initials: WX
authors.lastname: Tan
authors.forename: Zhong-yi
authors.initials: ZY
authors.lastname: Feng
authors.forename: Wei-li
authors.initials: WL
authors.lastname: Fu
authors.forename: Hong-wei
authors.initials: HW
authors.lastname: Guo
authors.forename: Gui-ling
authors.initials: GL
authors.lastname: Lang
authors.forename: Li-gang
authors.initials: LG
authors.lastname: Xi
authors.forename: Xiao-guang
authors.initials: XG
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Mao
authors.forename: Wen-cai
authors.initials: WC
authors.lastname: Lü
authors.forename: Xiao-liang
authors.initials: XL
authors.lastname: Wang
authors.forename: Shuo-dong
authors.initials: SD
authors.lastname: Wu
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.forename: Zhong
authors.initials: Z
authors.lastname: Tian
mesh_terms: 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