217例肝胆管结石治疗体会

SURGICAL TREATMENT OF HEPATOLITHIASIS IN 217 CASES

目的探讨外科治疗肝胆管结石的方式和疗效关系。方法回顾性分析从1990年1月到2004年12月217例肝胆管结石采用外科治疗的术式和治疗效果。其中肝门部胆管狭窄切开整形+胆肠吻合43例,肝叶切除术35例,胆肠吻合术72 例,胆总管切开取石T管引流术67例。结果术后有189例随访,随访6月-15年,采取胆管整形+胆肠吻合方式优良率达94． 9％以上,采取肝叶切除术方式优良率达80．6％以上,采取胆肠吻合术方式优良率达68．9％,其中有2例死亡,死亡率1．05％, 采取胆总管切开取石T管引流术优良率达67．2％。结论由于肝胆管结石时肝脏及胆道病变的复杂性和广泛性,常需将以两种或多种术式以及辅助技术方法的结合应用。

Objective To study the relationship between the choice of operation and curative effect of hepatolithiasis. Methods From Januray of 1990 to September of 2004. 217 patients with hepatolithiasis underwent surgical treatment were retrospectiuly analyzed . Of them 43 cases underwent plastic repair of hepatic portbile duct with cholangiojejunostomy, loberctomy of liver in 35 cases,cholangiojejunostomy in 72 cases ,choledocholithotomy with T-tube drainage in 67 cases . Result 189 cases were follow-up surveyed from 6 months to 15 years. The superior rate of plastic repair of hepatic port bile duct with eholangio-jejunostomy was 94.9% ,lobectomy of liver was 80. 6% ,Cholangio-jejunostomy was 67.2% （2 cases died ,the motality was 1.05%） choledoeholithotomy with T-tube drainage was 67.2% Conclusion Because the pathologic change of liver and Bile duct with hepatolithiasis is complex and extensive ,It can be treated by two or many choices of operation and accessory technology.