肝胆管结石168例的外科治疗

Surgical treatment for 168 cases of intrahepatic stone

[背景]探讨不同肝内胆管结石手术方式对术后残留结石发生率的影响.[病例报告]总结自2000年1月至2005年6月间给行手术治疗的肝胆管结石168例,其中左肝胆管结石为97例(57.7%),右肝胆管结石为33例(19.6%),左右肝胆管结石为38例(22.7%);合并肝外胆管结石为145例(86.3%);均行常规胆管切开探查取石术,并施行纤维胆道镜取石术,其中有37例行肝叶或肝段切除术.常规胆管切开探查取石后残留结石率为45.2%,肝切除术后残留结石率为18.9%,明显低于胆道探查组(52.7%),差异有统计学意义,经纤维胆道镜取石后最终残留结石率为7.14%.[讨论]肝切除术明显优于其他术式,术中纤维胆道镜的应用对于降低肝胆管结石术后残留结石率具有重要价值.

BACKGROUND To study the effect of different surgical treatment on the postoperative stone residual rate in intrahepatic lithiasis. CASE REPORTS 168 cases of intrahepatic lithiasis were summarized retrospectively, in which 97 cases （57.7 % ） of left hepatic calculus, 33 cases （19.6 % ） of right hepatic calculus, and 38 cases （22.7 % ） of bilateral hepatic calculus as well as 145 cases （86.3 % ） of combined with extrahepatic lithiasis. All patients were undergone choledochoscopy after exploration of bile duct. 37 patients were undergone hepatectomy. The postoperative stone residual rate of the group which was underwent exploration of bile duct was significant higher than that of the hepatectomy group （52.67 % vs 18.92 % ）. The final stone residual rate after choledochoscopy was 7.14%. DISCUSSION The outcome of h surgical treatments. The use of fiberoptic choledochoscopy is benefici residual rate ep al atectomy is superior to that of other to decreasing the postoperative stone