肝胆管结石合并肝门部胆管狭窄手术方式与疗效分析

Analysis of Approaches for Surgical Treatment of Hepatolithiasis Accompanied with Bile Stricture Near Porta Hepatis and Their Efficacy

目的 :分析肝胆管结石合并肝门部胆管狭窄的手术治疗方式与疗效的关系。方法 :回顾性分析 12 4例肝胆管结石合并肝门部胆管狭窄的术式及疗效。结果 :12 4例中 12 0例 (96 .8% )术后获得随访 ,随访时间为 6个月～ 2 0年 5个月 ,平均为 7年10个月。采取肝方叶切除、肝胆管切开取石、整形、高位胆肠吻合术式的 87例与采用其它术式的 37例比较 ,残石率、结石复发率及优良率分别为 19.8%和 38.9% (P <0 .0 5 ) ,7.7%和 2 2 .7% (P <0 .0 1) ,92 .0 %和 6 7.6 % (P <0 .0 1)。结论 :肝方叶切除是治疗肝胆管结石合并肝门部胆管狭窄的有效手段 ,采取肝方叶切除、肝胆管切开取石、整形、高位胆肠吻合术可明显提高病人的疗效。

Objective: To investigate the relationship between approaches and their efficacy for surgical treatment of hepatolithiasis accompanied with bile stricture near porta hepatis. Methods: Altogether 124 cases with hepatolithiasis receiving surgical treatment in our hospital were followed up. Results: 120 cases were followed up for an average of 7 years and 10 months. The residual calculus rate was 19.8% and 38.9% (P<0.05), recurring rate of calculus 7.7% and 22.7% (P<0.01), the excellent and good result rate 92.0% and 67.8%(P<0.01) in 87 patients undergoing the quadrate lobectomy, cutting open and taking rocks from bile duct, hepatobiliary stricture plasty, and hepatocholangiojejunostomy in the hepatic hilum and 37 patients without performance, respectively. Conclusion:Use of the quadrate lobectomy, cutting open and taking rocks from bile duct, hepatobiliary stricture plasty, and hepatocholangiojejunostomy during the operation can effectively promote the therapeutic efficacy of surgical treatment for hepatolithiasis accompanied with bile stricture near porta hepatis.