219例肝内胆管结石的外科治疗

Surgical Treatment for 219 Cases of Intrahepatolithiasis

目的:总结并评价肝内胆管结石的外科手术治疗效果。方法:单纯胆道探查T管引流72例,肝叶(段)切除和胆肠内引流109例,胆总管切开并胆道镜钬激光碎石术取石+T管引流38例。结果:总治疗优良率83.8%,并发症率15.1%,死亡率0.5%,结石残石率14.1%。胆总管切开合并胆道镜碎石术应用者明显优于其他组。结论:充分利用先进的诊疗技术,选择合理的术式,保留Oddi括约肌功能,可有效提高治疗效果,降低并发症及残石率。

To evaluate the result of the surgical treatment on patients with intrahepatolithiasis Methods In a series of patients with intrahepatic biliary duct stones, 72 cases underwent common bile duct exploration and T-tube insertion, 109 cases underwent hepatectomy and cholangioenterostomy, 38 cases underwent common bile duct exploration and T-tube insertion and cholangioscopic laser lithotripsy. Results The overall sufficient or complete remission rate was 83.8%, the postoperative complication rate was 15.1%, the surgical mortality rate was 0.5 % and the residual stone rate after operation was 14.1%. The results in the group of common bile exploration and T-tube insertion with choledochospcopic holmium laser lithotripsy was markedly better than those of the other groups Conclusion Choledochoscopy, holmium laser lithotripsy, appropriate surgical methods and preservation of the function of Oddi＇ s sphincter, all play an important role in the improvement of surgical results, lowering of postoperative complication rate and residual stone rate.