肝内胆管结石不同术式对结石残留及复发的影响

THE REMAINING AND RECURRING CONDITION OF CALCULUS IN THE INTRAHEPATIC BILE DUCT STONE PATIENTS DEALT WITH DEFFERENT OPERATION METHODS.

目的前瞻性研究肝内胆管结石不同术式对术后结石残留复发率的影响。方法选择167例肝内胆管结石病人,按肝内外胆管结石分布、胆管狭窄和并发症情况将病人分组,比较各组病人不同术式(胆总管切开取石术、胆肠内引流术、胆总管切开取石加纤维胆道镜取石术、肝叶/段切除术)下术后结石残留和二年内复发情况。结果初次手术选择胆总管切开加纤维胆道镜取石术或肝叶/段切除术,其术后残石率及结石复发率低于初次手术单纯行胆总管切开取石术者(P<0.05);肝叶/段切除术的术后残石率及结石复发率较胆总管切开加纤维胆道镜取石术有降低趋势;合并胆总管结石的病人行肝叶/段切除术或胆总管切开加纤维胆道镜取石术后,其残石率与无胆总管结石者无显著性差异(P>0.05)。结论肝内胆管结石较好的治疗方法为肝切除术或胆总管切开加纤维胆道镜取石术。

Objective To prospectively investigate the remaining and recurring rate of calculus in the intrahepatic bile duct stone patients dealt with different operation methods. Methods 167 eases of intrahepatie bile duct stone were chosen prospectively and divided into different groups according to the stone position, the diameter of bile duct, and the complications. In each group, different operation method was chosen freely, such as choledocholithotomy, internal drainage between bile duct and small intestine, choledocholithotomy combined choledochoscope, and hepatectomy. The remaining rate of calculus after operation was compared in each group, so was the recurring rate of calculus in 2 years after operation. Result The remaining rate and the recurring rate of calculus in the patients with hepatectomy were both lower than the patients with choledocholithotomy （P 〈 0. 05）, so was the remaining rate and the recurring rate of calculus in the patients with choledocholithotomy combined choledochoscope （ P 〈 0. 05）. The remaining rate and the recurring rate of calculus in the patients with hepatectomy seems lower than the patients with choledocholithotomy combined choledochoscope. The remaining rate and the recurring rate of calculus seems similar between the patients with or without common duct stones （P 〉 0.05）. Conclusion Hepatectomy or choledocholithotomy combined choledochoscope should be the superior surgical method of intrahepatic bile duct stone.