肝内胆管结石并高位胆管狭窄的外科治疗体会

Surgical therapy of intrahepatic bile duct stones with high hepatic duct stricture: 116 analysis of Patients

作者总结了１１６例肝内胆管结石并高位胆管狭窄患者的诊疗结果、经验和体会。此组病例占同期肝内胆管结石２７８例的４１．７２％。采用术前Ｂ超、ＰＴＣ，术中Ｂ超、胆道造影、胆道镜、手术探查及术后“Ｔ”管、“Ｕ”管造影确立诊断，联合运用高位胆管切开整形、胆肠吻合、肝叶段切除、胆道镜术中术后取石及“Ｕ”管支撑引流等不同的方式方法治疗，取得了满意的效果。术后残石率为７．７６％。经５个月～１０年的随访，随访率为８４．４８％，优良率为９２．２４％。１例死于感染败血症，死亡率为０．８６％。作者认为：在详尽影像学检查的前提下，合理选用并联合运用不同的方法是本病治疗的最佳选择。作者还对不同方法的适应证、技术要点进行了探讨。

Abstract These are the authors. experiense in the treatment of 116 cases of intrahepatic bile duct stones (IBDS)with high bile duct stricture (HBDS) out of a total of 278 IBDS patints. Comprehensive and systemic surgical therapy including high cholangiotomy and plastic operation,choledochojejunostomy, hepatolobectomy combined with removal of stones by cholangioscope after operation and long term T or U tube stent achieved good results. The operative mortality was 0. 86%, the residual stone rate was 13. 79%, and it was 7. 76% after cholangioscopy.Patients were followed up from 5 months to 10 years.Follow-up rate is 84. 48%,good result was achieved in 92. 24% of all patients.