原发性胆管结石的外科治疗

Surgical Treatment of Primary Biliary Lithiasis

本文报道301例原发性胆管结石分别采用胆总管空肠Roux-en-Y吻合术209例，（69．4％）；同时行肝部分切除72例，（23．9％）；左／右肝管肝总管空肠吻合56例，（18．6％），行肝部分切除28例，（9．3％）；肝外左、右肝管汇合部切开＋原位整形＋T管引流术36例，（12％），行肝部分切除7例，（2．3％）。全组共行肝部分切除术107例，（35．5％）。结果表明：术后出现吻合口胆漏3例，吻合口出血1例，伤口感染等19例，总并发症发生率7．6％。死亡2例，（0．7％）。随访5年以上268例，随访率89％。疗效优良率为256例，（95．5％）。术后残石率15例，（5％）。提示加强术前诊断与准备，选用肝部分切除＋胆肠大口径侧侧吻合可提高疗效，减少残石率和并发症。

This article reported 301 patients with primary biliary lithiasis were treated by surgery,which was choledochojejunostomy in 209 cases (69. 4 % ),of them 72 (23. 9% )with a partial hepatectomy, 56 (18- 6 % )left or right hepaticojeunostomy, of them 28 (9. 3% ) with partial hepatectomy, 36(12 % ) opening at the hepatic bifurcation with orthoplasty and T tube drainage,of them 7 with partial hepatectomy was performed for 107 cases (35. 5 % ). The result showed 4 occured post-operative bile leakage and bleeding at the anastomosis and 19 wound infection. The morbidity accounted for 7. 6%,and the postoperative mortality is 0. 7 % (2/301 ). Two hundred and sixty-eight cases followed up more than 5 years,which rate was 89%. The good effective rate accounted for 95. 5% (256/268) and the residual stones rate post-operatively 5 % (5/301 ). It is suggested that the diagnosis and management emphasized be fore operation and the partial liver resection with widely side-side cholecochojejunostomy should be improved the effect and reduced postoperative complication.