术中胆道镜在238例规则性肝段切除治疗肝胆管结石患者中的应用

Value of intraoperative choledochoscopy in anatomic hepatectomy for hepatolithiasis

目的探讨术中胆道镜在规则性肝段切除治疗肝胆管结石患者中的应用价值。方法回顾性分析2000年1月至2004年12月采用规则性肝段切除术联合术中胆道镜治疗238例肝胆管结石患者的临床资料及远期疗效。结果术后并发症发生率为16.0%(38/238),死亡率为2.1%(5/238),单纯肝段切除肝内胆管结石清除率为36.1%(86/238),应用术中胆道镜取石治疗后肝内胆管结石清除率提高至87.4%(208/238),结合术后胆道镜取石治疗后胆管结石清除率达98.3%(234/238)。220例患者平均随访39个月,95.9%(211/220)获得优良疗效,其中84.5%(186/220)完全无症状,11.4%(25/220)偶有轻度胆管炎发作;4.1%(9/220)患者因反复发作严重胆道感染而需进一步手术处理。结论在规则性肝段切除治疗肝胆管结石患者术中,应用胆道镜不仅有助于术者选择正确的肝切除,而且作为辅助的治疗手段,能明显减少结石的残留率,从而有助于提高肝胆管结石患者的手术疗效。

Objective To investigate the value of clinical application of intraoperative choledochoscopy in anatomic hepatectomy for hepatolithiasis. Methods Two hundred and thirty-eight patients with hepatolithiasis underwent anatomic hepatic resection companied with intraoperative choledochoscopy from January 2000 to December 2004. The clinical data were recorded and studied retrospectively, and patients were followed up after discharge. Results The operative mortality was 2.1% （5/238）, and the complication rate was 16.0% （38/238）. In 86 cases （36.1% ）, the stones were thoroughly removed with anatomic hepatic resection. In 208 cases （87.4%）, the stones were thoroughly removed with anatomic hepatic resection and intraoperative choledochoscopy. Follow-up on 220 patients for an average of 39 months showed that 84.5 % （186/220） were symptomfree, and 11.4% （25/220） had occasional mild attacks of cholangitis, and 4.1% （9/220） had severe cholangitis requiring further surgical intervention. Conclusion Intraoperative choledochoscopy is of great value in anatomic hepatectomy for the treatment of hepatolithiasis. It can conspicuously reduce residual stones and effectively improve the curative effect.