Repair Hilar Bile Duct Strictures In Primary Hepaticlithiasis Patients With Self-tissue (46 Cases Reported)

Objective: To explore the therapeutic method and efficacy of repairing hilar bile duct strictures with self-tissue in the patients who suffered from hepaticlithiasis.Methods: Forty-six cases of hepaticlithiasis with hilar bile duct strictures were studied retrospectively. Surgical management: Rapair the strictures with pedicled gallbladder graf combined with hepatectomy in 10 cases; repair with pedicled gallbladder graft in 30 cases; repair with pedicled umbilical vein graft in 4 cases; repair with pedicled gastric wall in 2 cases, and choledochoctomy were been done in every cases.Result:1.Location of stones: 2 case in the left intrahepatic duct; 14 cases in the right intrahepatic duct; and 30 cases in both the left and right intrahepatic duct .2.Location of strictures: 10 cases in the right hepatic duct; 4 cases in the right hepatic and the common hepatic duct ; 4 cases in the left hepatic and common hepatic duct;5 cases in the left and right hepatic duct; 6 cases in the left hepatic duct,the right hepatic and the common hepatic duct , 4 cases in the confluence of left and right ducts; 13 cases in the common hepatic duct.3.Postoperative complications occer in 5 cases. The complications were wound infection,pulmonary infection and bile leakage. And there was no surgical mortality in this study.4.Postoperative stone residual: The diagnosis of postoperative stone residual was based on the cholangiogram and ultrasound .The stone residual rate was 13.0%(6/46).5.With a long-term follow-up , the excellent rate was 90.2%.Conclusion:1.Before the operation, examination should be done to know the location and the degree of the stones and the duct structure. It's usefull to make the operation plan,and reduce the residual stones.2. The principles for the treatment of primary hepaticlithiasis with hilar bile duct strictures are complete clearance of stones, preserving the function of the sphincter of Oddi by repairing the stricture with self-tissue.That can prevent the enteric biliary reflux, and keep the bile duct in a good physiological environment.3.As the repairing tissue, pedicled gallbladder graf is very useful. It's useful to preserve the gall bladders ,when the operations were performed in the hepaticlithiasis patients without obvious pathological changes.