纤维胆道镜在治疗肝内胆管结石中的应用

Clinical application of choledochofiberscope to intrahepatic biliary calculi

目的探讨纤维胆道镜在治疗肝内胆管结石中的应用价值。方法收集1996年10月～2006年10月肝内胆管结石患者336例临床资料,进行分析及总结。结果336例肝内胆管结石患者术中用常规方法取石残石率为33.93%,术中结合纤维胆道镜取石残石率降至13.10%,术后再应用纤维胆道镜取石残石率降至8.04%。336例手术方式中,胆管外引流(T管引流)134例,肝段或亚肝段切除加胆管外引流(T管引流)113例,肝段或肝亚段切除加胆肠内引流17例,胆肠内引流72例。结论纤维胆道镜在治疗肝内胆管结石具有重要的作用。术中术后应用胆道镜可降低残石率,术中胆道镜能明确术前未能确诊的病变,并有利于术中正确选择手术方式。

[Objective] To evaluate the clinical application of choledochofiberscope to the intrahepatic biliary calculi during and after operation. [Methods] The clinical data of 336 cases with intrahepatic biliary calculi from October 1996 to October 2006 were collected and analyzed. [Results] Compared to the traditional method, the calcull residue rate of 336 cases dropped from 33.93% to 13.10% and 8.04% （P〈0.01） with the help of chledochofiberscope during and after operation. Among them, 134 cases were treated by outside bile duct drainage （T-tube）, 113 cases by lobectomy or segment hepateetomy combined with outside bile duct drainage （T-tube）, 17 cases by lobectomy or segment hepatectomy combined with cholangioenterostomy, 72 cases by cholangioenterostomy. [Conclusion] Choledochofiberscope plays an important role in the treatment of intrahepatic bi]iary calculi. The choledochofiberscope used in and after operation can remarkably decrease calculi residue rate. Moreover, applying choledochofiberscope in the course of operation can ascertain pathological changes which are confused before operation and benefit the choice ofproper operation methods.