肝内胆管结石185例的临床治疗

Surgical Treatment for 185 Cases of Intrahepatolithiasis

目的:总结肝内胆管结石的外科手术治疗效果。方法:单纯胆道T管引流60例,肝叶(段)切除和胆肠内引流89例,胆总管切开并胆道镜钬激光碎石术取石+T管引流36例。结果:总治疗优良率81.1%,并发症率14.2%,死亡率1.1%,结石残石率14.1%。胆总管切开合并胆道镜碎石术应用者明显优于其他组。结论:利用先进的诊疗技术,选择合理的术式,可有效提高治疗效果,降低并发症及残石率。

Objective： To evaluate the surgical treatment on patients with intrahepatolithiasis. Methods： In a series of patients with intrahepatie biliary duct stones, 60 cases underwent common bile duct exploration and T-tube insertion. 89 cases underwent hepatectomy and cholangioenterostomy, 36 casese underwent common bile duct exploration and T-tube insertion and cholangioscopic laser lithotripsy. Results： The overall sufficient or complete re-mission rate was 81.1%, the postoperative complication rate was 14.2%, the surgical mortality rate was 1.1% and the residual stone rate after operation was 14.1%. The results in the group of common bile exploration and T-tube insertion with choledochospeopic holmium laser lithotripsy was markedly better than those of the other groups. Conclusion： Choledochoscopy, holmium laser lithotripsy, appropriate surgical methods, all play an important role in the improvement of surgical results, lowering of postoperative complication rate and residual stone rate.