肝胆管结石的治疗

Management of hepatolithiasis

在３１９例肝胆管结石病例中，肝内型占１５％，肝内外型占８５％；４６％伴有胆管狭窄．对肝内型病例．以高位胆管切开整形、胆肠吻合．肝叶、段切除为基本术式。对肝内外型．以上述术式处理肝内病变．并附加肝外胆肠内引流术。对多次手术．肝门部严重粘连、无法分离者，行肝叶、段切除术．残石率４８％。为提高肝胆管结石的疗效，强调术前、术中详尽的影像检查．合理选用并联合应用不同术式及术后纤维胆道镜取石的综合治疗。

patients with hepetolithiasis treated in our institution were reviewed. The intrahepatic type of hepatolithiasis(I Type)constitues 15% of all the patients and intra-and extrahepatic type(IE Type), 85%. 46% accompanied bile duct strictrues. The orthoplasty of hilar bile duct, cholangiojejunostomy or resection of lobe or segments of the liver were performed for the I type; For the IE type, besides the above procedure, binary-enteric anastomosis was also performed. Resection of lobe or segments was favored for the patients undergone multiple operations with serious adhesion at the hilium of the liver. Retained stone rate was 48%. In order to improve the therapeutic effectiveness of hepatolithiasis, it is emphasized on detailed pre-and intraoperative imaging examinations, rational selection and combination of various procedures, and postoperative endoscopic lithotomy.