手术治疗肝内胆管结石68例疗效观察

Curative effect of surgical treatment for hepatolithiasis in 68 cases

目的探讨手术治疗肝内胆管结石的适宜方法及其疗效。方法该院于2002年7月～2007年12月共收治肝内胆管结石患者68例,施行肝叶(段)切除术13例,肝门胆管切开取石+高位胆管空肠Roux-en-y吻合术15例,肝叶(段)切除+胆管空肠Roux-en-y吻合术9例,单纯胆总管切开取石+T管引流术31例,术中胆道镜取石21例、术后胆道镜取石13例。结果术后有61例获得6个月～3年随访,其中优30例,良24例,差7例,优良率88.5%,术后残余结石11例(16.2%),经术后胆道镜结合液电碎石治愈10例,再次手术1例,胆瘘2例,伤口感染3例,膈下脓肿1例,均经非手术治疗痊愈。未发生手术死亡。结论肝叶(段)切除+胆肠吻合引流术或T管引流术+术中胆道镜治疗肝内胆管结石能提高疗效、降低残石率、减少并发症,术后胆道镜取石是治疗胆道残石的重要措施。

[Objective] To explore the optimal methods and curative effect of surgical treatment for hepatolithiasis. [Methods] Of the 68 patients with hepatolithiasis who were hospitalized in our hospital from June 2002 to December 2007, 13 cases received hepatolobectomy（hepatic segmentectomy）, 15 cases received hepaticolithotomy plus Roux-en-Y cholangiojejunostomy and 9 received hepatolobectomy （hepatic segmentectomy） plus Roux-en-Y cholangiojejunostomy. Simple choledochotomy and calculus removal plus T-tube drainaged in 31 cases. Intraoperatire and postoperative choledochoscopic calculus removal was performed in 21 and 13 cases, respectively. [Results] Postoperative follow up was carried out for 6 months to 3 years in 61 cases： excellent results in 30 cases, good in 24 and fair in 7. The excellent and good rate was 88.5%. Postoperative residual stones occurred in 11 cases （16.2%）. 10 cases with debris were cured by electrohydraulic lithotripsy （EHL） with choledochoscopy and 1 received reoperation. Bile leak occurred in 2 cases, incision infection in 3, subphrenic abscess in 1. All the complications were cured by non-operative treatment. No perioperative mortality existed. [Conclusion] Hepatolobectomy （hepatic segmentecto- my） plus Roux-en-Y cholangiojejunostomy or T tube drainage combined with intraoperative choledochoscopy is capable of improving clinical outcome, reducing the incidence rate of postoperative debris and complications in the treatment of hepatolithiasis. Postoperative choledoehoscopy is an important step for removing debris in biliary tract.