以肝段切除为主的联合手术治疗肝内胆管结石

Combination of Hepatolobectomy with other operations for treatment of Intrahepaticolithiasis

目的探讨肝内胆管结石外科治疗的方法,以提高该病的治疗水平。方法回顾性分析近10年来56例行以肝段切除为主的联合手术治疗的肝内胆管结石患者的临床资料。结果术后围手术期死亡1例(1.8%),其他并发症5例(8.9%):肺部感染1例(1.8%),胆漏3例(5.4%),膈下脓肿1例(1.8%)。全组随访时间0.5～8.2年,48例无自觉症状(85.7%),3例(5.4%)有胆道感染表现,2例(3.6%)于Ⅰ或Ⅶ段仍有残余结石,3例(5.4%)于术后2～5年出现结石复发。结论肝内胆管结石患者应采用肝段(叶)切除联合高位胆管切开取石、肝胆管空肠吻合手术,并配合术中纤维胆道镜及术中B超定位取石,有利于提高疗效。

Objective To discuss the method of surgical treatment for intrahepaticollthiasis,and to improve its therapeutic effect. Method In recent 10 years, 56 cases of intrabepaticolithiasis in his hospital were treated by combination of bepatolobectomy with other operations, and the results of these cases were retrospectively analyzed. Results One patients（ 1.8% ） died after operation, 5 patients（8.9% ） had complications including pulmonary infection （ 1 ease 1.8% ）, biliary fistula （3 cases 5.4% ） and subphrenie abscess （ 1 eases 1.8% ）. All cases were followod -up for 0.5 - 8.2 years, 48 cases（ 85.7% ） had not any symptom, 3 cases（ 5.4% ） had infection in biliary tract, 2 cases（3.6% ） had retained calculi in I or Ⅶ section, 3 cases（5.4% ） had recurred calculi 2 - 5 years after operation. Conclusion Intrahepaticolithiasis can be treated by combination of hepatolobectomy with cholangio - jejunostomy and other operations, thus its therapeutic effect can be improved.