胆肠内引流术在肝内胆管结石治疗中的应用

Clinical analysis of cholangioenterostomy for intrahepatic bile duct stone.

目的评价各型胆肠内引流术在治疗肝内胆管结石中的作用.方法回顾性分析我院1982～2001年手术治疗的1232例肝内胆管结石病人资料,对其中的334例胆肠内引流术病例的适应证、方法及其效果进行总结.结果胆肠内引流组发生术后并发症57例(发生率17.1%).死亡5例,分别死于腹腔内出血、吻合口瘘及肝功能衰竭等.近5年中因肝内胆管结石而行胆肠内引流术者无1例死亡及发生严重并发症.结论胆肠内引流术在肝内胆管结石的处理上有重要的作用,但随着肝切除在临床上推广,胆肠内引流术逐步减少,其适应证亦愈来愈严格;它对不能切除的胆管狭窄有重要意义;胆总管十二指肠内引流术治疗肝内胆管结石的方法应摒弃.

Objective To discuss the method and effect of cholangioenterostomy for intrahepatic bile duct stone.Methods From 1982.1 to 2001.12, 334 patients suffering from intrahepatic bile duct stone underwent different types of cholangioenterostomy. Clinical date of the patients were retrospectively analyzed. Results Nineteen cases out of 334 patients with cholangioenterostomy were subjected to choledochoduodenostomy, 11 to interposed jejunal choledochoduodenostomy plus Roux-en-Y cholangioenterostomy.Conclusion With using hepatectomy for intrahepatic bile duct stone, cholangioenterostomy is performed lesser. Cholangioenterostomy is a better operative method for stenosis of bile duct. Choledochoduodenostomy must be abstained for intrahepatic bile duct stone.