复杂性肝内胆管结石的外科治疗(附141例分析)

ANALYSIS OF THE SURGICAL TREATMENT FOR 141 CASES WITH COMPLICATED INTRAHEPATOLITHIASIS

目的总结并评价复杂性肝内胆管结石的外科治疗效果。方法回顾性分析1999年1月～2002年5月141例复杂性肝内胆管结石患者各种外科治疗方法,分析术式选择及治疗效果。结果1141例中曾有1～4次胆道手术史者共45例,合并局部肝萎缩、胆汁性肝硬化、门脉高压、重症胆管炎或肝脓肿等共126例;本次共行肝叶(段)切除96例,单纯内引流术31例,单纯胆道探查T管引流14例,术中常规B超及胆道镜检查。结石残留病例予术后胆道镜取石共72次。2总治疗优良率87.2%(123/141),并发症发生率23.4%(33/141),死亡率1.4%(2/141),结石残留率22.7%(32/142)。3肝切除组优良率91.7%(88/96),最终残石率7.3%(7/96),明显优于其他术式组。432例结石残留病例经术后胆道镜取石,8例取净,使最终残石率降为16.9%。结论充分利用先进诊疗技术,合理的术式选择,可有效提高治疗效果,降低并发症及残石率。

Objective To evaluate the results of the surgical treatment on patients with complicated intrahepatolithiasis. Methods The data from 141 cases with complicated intrahepatolithiasis admitted from Jan. 1999 to May. 2002 were reviewed, the outcome of surgical treatment was analyzed.Result Fortyfive patients (31.9%) had undergone one or more biliary procedures,126 patients (89.4%) were complicated with cirrhosis,severe cholangitis or liver abscess. In terms of surgical treatment, 96 patients(68.1%) underwent hepatectomy, 31 cases(22.0%) did cholangioenterostomy,and 14 cases(9.9%) did T-Tube insertion.One hundred and twenty-three patients(87.2%) were sufficiently or completely remission, while the rate of postoperative complications was 23.4%, and surgical mortality was 1.4%. The rate of residual stones after the operation was 22.7%, but decreased to 16.9% after cholangioscopy.Compared with cholangioenterosromy and T-tube insertion, hepatectomy demonstrated a lower rate of residual stones (7.3%vs37.8%,P<0.05), and a effective curative rate (91.7%vs75.6%,P<0.05).Conclusion The results show that modern technique and instrument such as cholangioscopy may play an important role in the treatment of hepatolithiasis.Hepatectomy seems to be the most effective treatment for selected patients.