上海地区原发性肝内胆管结石的特点

PRIMARY INTRAHEPATIC BILE DUCT STONES IN SHANGHAI

本文综合上海地区9所医院5年内(1981～1985)经手术证实的340例原发性肝内胆管结石,并对上海地区的发病率、诊断方法、治疗方法等进行了分析。上海地区的肝内胆管结石发病率是同期胆道疾病的2.31％,是胆石症的4.56％。郊区发病率高于市区。术前诊断依靠B超,从中了解肝内胆道扩张和结石的情况,术中诊断除作胆道探查外,还采用胆道镜及胆道内造影。治疗方法以肝部分切除术疗效最佳,其次为胆肠引流。仅作胆道切开取石加引流者疗效较差。有104例并发AOSC者被迫作急症手术,仅作胆道切开取石加引流,残石率较高。

This is a retrospective review of 340 cases of primary intrahepatic bile duct stones from 9 hospitals in different districts of Shanghai during 1981-1985. Primary intrahepatic biliary stones account for 2.31% of biliary tract diseases and 4.56% of total bile stones. They are more prevalent in urban areas. Preoperative diagnosis depended mainly on ultrasonography to determine the sites of stones and dilatation of intrahepatic ducts. Some cases wore diagnosed by intraoperative exploration of biliary tract with probes, choledochoscope and/or cholangiogram. For the treatment of intrahepatic biliary stones, partial hepatectomy was the most effective; internal drainage procedures like hepatico- or choledochojejunostomy were also satisfactory; choledochostomy and external drainage did not solve the problem of multiple and recurrent stone. Immediate choledo chostomy and drainage with T-tube had to be performed in 104 cases complicated with acute obstructive sclerosing cholangitis (AOSC). However, the frequency of residual stones in such cases was rather high. For this reason, the authors suggest that for critical patients with AOSC, PTCD should be done first and delayed curative operation is carried out later.