肝内胆管结石外科治疗的选择

Selection of surgical treatment for hepatolithiasis

目的 :探索如何选择更合理的术式治疗肝内胆管结石(CID)。方法 :回顾性分析15年中226例肝胆管结石外科治疗 :单纯胆(肝)总管切开取石和引流术(CS)69例 ;CS加术中、术后纤维胆道镜检取石术(FC)66例 ;胆 -肠内引流术(BED)52例 ;肝部分切除术(PH)28例 ;联合手术(CO)11例。结果 :CS及BED疗效较差 ;CS加FC及PH和CO有较好效果。结论 :肝内胆管结石手术应根据结石分布类型和伴随的病理变化以解除梗阻、去除病灶、通畅引流为基本要求 ,个体化地选择术式 ,术中应把时间和精力放在解除梗阻、去除病灶上 ,胆肠内引流只作为补助性治疗措施。

Objective: To investigate the selection of more reasonable operative approaches of calculus of intrahepatic duct(CID).Methods: The surgical treatment for 226 cases of CID in the past 15 years were retrospectively analyzed. Of these 226 patients, 69 patients received choledochostomy(CS),66 CS plus intra- and postoperative fibrocholedochoscopic management (FC),52 bilio-enteric drainage (BED),28 partial hepatectomy (PH) and 11 combined operation (CO).Results:The therapeutic effects of simple CS and BED were poor while those of CS plus FC, PH and CO were better.Conclusion:Operations for CID should be performed according to the type of distribution of stones and pathological modification following the principle of relieving obstruction, removing pathological foci and expediting drainage. The personalized operative procedure shoutd be selected to focus on relieving obstruction and removing pathological foci.Furthermore, cholangiojejunostomy should be used as an auxiliary therapeutic measure.