1559例肝内胆管结石的外科治疗

SURGICAL TREATMENT OF INTRAHEPATOBILIARY TRACT STONES OF 1559 CASES

作者对安徽医科大学附属医院１９８１年１２月至１９９７年１０月期间经手术及胆道镜处理的１５５９例肝内胆管结石病例进行了总结，其中左肝管结石３３２例（占３３．９％），右肝管结石１１１例（１１．３％），左右肝管均有结石５４５例（占５４．７％）。３２４例（３２．３％）合并有胆管狭窄，其中左肝管狭窄１５６例（４８．２％），右肝管狭窄１０７例（３３．０％），肝门胆管狭窄６１例（１８．８％）。手术方式主要有：①肝叶或肝段切除；②高位胆管狭窄切除；③胆肠内引流术；④Ｔ管及Ｕ管外引流以及术后经Ｔ管或Ｕ管瘘道纤维胆道镜取石。作者认为手术术式的选择主要取决于肝内胆管结石类型及其病理分期。该组资料还表明纤维胆道镜在处理肝内胆管结石病例中起到了重要作用。

From December 1981 to October 1997, we had performed 1559 cases of intrahepatobiliary tract stones by surgery alone/or with cholangioscopy, of which 332 cases were left intrahepatobiliary tract stones (accounted for 33.9%), 111 right intrahepatobiliary tract stones (accounted for 11.3%) and 545 cases in both sides (54.7%). 324 patients complicated with stricture of biliary tract (32.3%), of which 156 cases (48.2%) were stricture of left intrahepatobiliary tract, 107 cases (33.0%) stricture of right intrahepatobiliary tract, 61 cases (18.8%) stricture of hepatic hilus biliary tract. The operative procedure were: ①hapatic lobe or segment resection, ②high cholangiotomy and palstic repair, ③choledochojejunostomy and ④T tube or U tube drainage with removal of stones by cholangioscopy later. The operative procedure should be based on different types of intrahepatobiliary tract stones and patholigical features. The result indicates that cholangioscopy may play an important role in the treatment of intrahepatobiliary tract stones.