难治性胆石病的外科手术经验

Surgical experience in the treatment of refractory cholelithiasis

目的探讨难治性胆石病的手术方式与技巧。方法回顾性分析1990年1月至2007年12月湖南省人民医院肝胆外科收治的521例难治性胆石病患者的临床资料。结果全组均行手术治疗，3例术后围手术期内并发肝。肾功能衰竭死亡，其余518例无严重并发症发生，痊愈出院。经B超和CT复查有结石残留者78例，占15．1％。423例获随访，随访5个月至17年，平均随访时间7．5年，随访率81．7％。效果良好率达90．1％（381／423）。结论大部分难治性胆石病患者可以根治；根据患者的具体情况，采用相匹配的个体化手术方案、精细规范的手术操作是保证疗效的关键。

Objective To investigate the operative techniques for refractory cholelithiasis. Methods The clinical data of 521 patients with refractory cholelithiasis who had been admitted to People＇s Hospital of Hunan Province from January 1990 to December 2007 were retrospectively analyzed. Results All patients received surgery. After the operation, 3 patients died of liver and kidney failure, the remaining 518 patients were cured without severe complications. The results of B ultrasound and computed tomography showed residual stones in 78 patients （ 15.1% ）. Four hundred and twenty-three patients （81.7%） were followed up for 5 months to 17 years （mean, 7.5 years）, and the rate of positive effect was 90.1% （381/423）. Conclusions Most of the refractory eholelithiasis can be cured radically. Individualized surgical planning, fine and standard surgical procedure are key to the treatment effect.