双侧肝胆管结石伴狭窄的病变特点与手术方式的选择

Clinical-Pathological Characteristics and Rational Selection of Operative Procedures for Double Intrahepatic Biliary Calculi and Stricture

目的:根据双侧肝胆管结石伴狭窄的病变特点来探索外科手术方式。方法:根据双侧肝胆管结石伴狭窄病变特点,将其分为3 型,选用不同的以肝段切除为主的联合手术。结果:全组无手术死亡。术后近期并发感染、胆漏、肝功能不全,消化道出血共12例,均经保守治疗痊愈。残留结石8例,术后经胆道镜取净结石6例。58例经1-10年随访,其中优57．9％、良32．3％、差10．8％。结论: 双侧肝胆管结石伴狭窄外科治疗的关键是按照病变的特点切开肝内各叶段胆管狭窄段、取净结石、建立通畅的胆流通道。以肝段切除为主的不同的联合手术是治疗双侧肝胆管结石伴狭窄安全有效的方法,值得推广使用。

Objective： To evaluate the method and result of surgical treatment for double intrahepatic biliary calculi and stricture. Methods： From1990to2003 ,based on pathological feature ,65 patients were admitted for double intrahepatic biliary calculi and stricture, patients undergone biliary lithotomy by multiple incision made on the bile duct strictures disseminating on different hepatic lobes and segments, hence the exposure of the strictured duct and the bile ductplasty after the cholangiotomy was the major challenge. Results： There was no mortality. Residual stones were removed through cholangioscopy in 6 of 8 cases. 58 cases were followed up from 1 to 10 years,The good rates were 89. 2% ,the rates of residual calcui and reoperation were 12.3% ,4. 6% repectively. Conclusion：The key of the surgical treatment of double intrapatic calculus include incision and exposure of the stricture of the intrahepatic bile duct, removing the stone and reconstructing bile drainage. The combined operative including systematic segmentectomy is effective and safe for double intrahepatic calculus and stricture.