肝胆管结石并高位胆管狭窄的诊断和治疗

Diagnosis and treatment of the hepatolith complicated high-positioned biliary duct stenosis

对１２７例肝胆管结石并高位胆管狭窄．用Ｂ超（术前及术中）、ＰＴＣ、术中胆道镜、结合手术探查确诊。采用联合手术，包括肝叶切除，经肝门（包括肝方叶切除）途径切开肝总管．左、右Ⅰ、Ⅱ级肝管．取石、狭窄胆管整形，高位胆肠吻合术治疗。经１～９ａ随访：总优良率８５．３１％，其中肝叶切除病例的优良率８９．５８％。

cases with hepatolith complicated high binary duct stenosis were treated between 1983 and 1992. 54 cases were men and 73 cases women. The age of the patients ranged from 23 to 62 years. 63 of the patientS had history of binary duct operations about 1-3 times beforehad. The B ultrasound before or during Operation, PTC, choledochoscope and exploration were applied for confirming diagnosis. Among them, it was found that there were 3 cases with left hepatic duct stones; 3 cases with left and right hepatic stones; 36 cases with left hepatic duct stones complicated extrahepatic stones:85 cases with left and right hepatic stones complicated extrahepatic stones. 33 cases had stenosis in one-positioned and 94 cases had stenosis in two or more than two-POsitioned. The combined operations were included as following: the lobectomy of liver; incision of the common hepatic duct, left and right hepatic ducts and Ⅱ-staged hepatic ducts; lithotomy through the hepatic portal (including the resection of the quad-rate lobe) l the binary duct stenosis plasty and highpositioned cholangioenterostomy. The patients were followed up from 1 to 9 years. The results indicated that 85. 71 % of total cases with these treatment had excellent effect in which 89. 58% of the cases Were Performed by lobectomy. In order to take out stones as clearly as possible, the diagnosis of hepatolith, exposition and incision of stenosis of hepatic duct, indication and advantage of liver lobectomy are discussed herewith.