难治性胆石病的外科手术经验-附521例报告

Surgical experience of refractory cholelithiasis： a report of 521 cases

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医院收治的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，除3例术后围手术期并发肝肾功能衰竭死亡，其余518例无严重并发症、痊愈出院。经影像学检查有残石者78例，占15．0％。423例获随访，随访率为81．7％，平均随访时间7年6个月（5个月～17年）。效果良好率达90．1％。结论大部分难治性胆石病可以根治，个体化的手术方案、精细规范的手术操作是保证疗效的关键。

Objective To summarize the experience in operation manner and surgical technique of re- fractory eholelithiasis. Methods A total of five hundred and twenty one patients with refractory cholelithiasis admitted to Hunan Provincial People＇ s Hospital from Jan. 1990 to Dec. 2007 were involved in this study for retrospective analysis. Results All patients in this group accepted surgery. Apart from three eases of perioperative death with liver and kidney failure, the remaining five hundred and eighteen cases had no serious complications, were cured and discharged. The imaging examination showed residual stone in seventy cases, accounting for fifteen percent. Four hundred and twenty one patients were followed up. The mean time of follow-up was seven years and six months （range 5 months - 17 years）. Good result rate was 90.1% （381/423）. Conclusions Most intractable cholelithiasis can be cured radically. Individual surgery pro- gramme, fine and standard surgical procedure are the key to treatment effect.