肝内胆管结石并胆管狭窄的治疗

Therapy of Intrahepatic Bile Duct Stones Accompany with Bile Duct Stricture

为探讨肝内胆管结石并胆管狭窄的外科治疗，对１０年来收治的１６８例肝内胆管结石并胆管狭窄的术前检查、结石及狭窄的部位和分布情况、手术方式、手术后并发症及残余结石的处理进行了分析。结果显示：１６８例中，左肝内胆管结石、全肝结石和右肝内胆管结石分别是８３，５９和２６例；左外叶及左半肝切除１１６例；右肝段切除２２例；高位胆管切开整形胆肠大口吻合９６例；残石率３％；１３例出现手术后并发症；随访１４２例，优良效果９６．５％。结果提示肝叶、肝段切除联合肝胆管空肠大口吻合是肝内胆管结石并胆管狭窄的最佳治疗选择。

To evaluate the treatment of intrahepatic bile duct stones accompany with bile duct stricture, we have retrospectively analyzed the data of 168 cases of hepatolithiasis treated in our hospital in the past 10 years, including preoperative examinations, location and distribution of stones and stenosis, modalities of operation, postoperative complications, and residual stones. The results showed that among the 168 patients, 83, 59 and 26 patients had left lobe hepatolithiasis, both lobes hepatolithiasis and right lobe hepatolithiasis respectively; 112 had left lateral lobectomy, 4 had left lobectomy, 22 had right hepatic segmentectomy; of them 96 underwent high cholangiotomy and plasty and wide anastomosis hepatocholangioejunostomy. The residual rate was 3%, postoperative complications occurred in 13 cases. One hundred and fortytwo patients were followed up, good result was achieved in 96.5%. The results suggest that hepatic lobectomy or segmentectomy with anastomosis wide hepatocholangiojejunostomy is the best choice of surgical therapy for hepatolithiasis complicated with bile duct stricture.