肝内胆管结石的外科治疗

Surgical therapy of intrahepatic bile duct stones

目的 探讨肝内胆管结石并胆管狭窄的手术治疗。方法 回顾性分析1992年前后两个时段组收治的肝内胆管结石4 2 6例的外科治疗效果。结果 1992年后时段组与1992年前时段组比较,肝切除率大幅上升(88.8% :19.7% ,P <0 .0 5 ) ;胆肠内引流率明显下降(2 2 .9% :72 .3% ,P <0 .0 5 ) ;术后残石率、再手术率明显下降(3.6 %、1.6 % :18.0 %、12 .1% ,P <0 .0 1) ,优良效果率显著提高(96 % :81% ,P <0 .0 5 )。结论 肝叶、肝段切除术是肝内胆管结石并胆管狭窄的最佳治疗选择,肝胆管空肠大口吻合只适用于肝门部胆管狭窄。

Objective To evaluate the curative effect of surgery in intrahepatic bile duct stones with bile duct stricture. Method From January 1985 to December 2003, 426 patients with intrahepatic bile duct stones were analyzed retrospectively. Results Compared with the cases before 1992, the rate of hepatectomy in cases after 1992 obviously increased (88.8%:19.7%,P<0.05), while hepatocholangioenterostomy declined (22.9%:72.3%,P<0.05), the postoperative residual rate and re-operation rate obviously declined (3.6%:18.0% and 1.6%:12.1%,P<0.01); curative effective rate increased (96%:81%,P<0.05). Conclusions Hepatic lobectomy or segmentectomy is the best choice of surgical therapy for intrahepatic bile duct stones. Wide anastomosis of hepatocholangiojejunostomy apply only in the hepatic portal biliary stenosis.