肝胆管结石并高位胆管狭窄的外科治疗

Surgical Treatment of Intrahepatic Stones with High Biliary Stricture

治疗肝胆管结石并高位胆管狭窄７４例。术中通过高位胆管的充分暴露，１～３级胆管切开整形、肝切除的正确应用，纤维胆道镜检及取石，大口胆肠内引流等多种手术的联合使用，提高了手术疗效，降低了残石率．认为术前详细的路道影像学检查、对手术难度的充分预测、术式的正确选择等非常重要．强调术中病肝切除的重要性．

cases of intrahepatic stones with high biliary strictures were treated with the combination of various surgical precedures, including full exposure of primary to tertiary hepatic ducts from hepatichilam, plastic repair of the structured ducts, reasonable use of hepatic lobectomy with flexible choledochoscope and choledojejunostomy. Results showed that the effect of operation were strikingly improved and the rate of retained stones were reduced.We suggest routine preoperation cholangiography for recognizing the difficulty of operation and correct choice of various operation procedures.