肝内胆管结石的外科治疗

SURGICAL TREATMENT OF INTRAHEPATIC BILE DUCT STONES

作者总结了195例肝内胆管结石的治疗经验。采用术前B超、PTC、术中B超胆道镜等方法检查,确定结石位于左肝85例(43.6％),右肝36例(18.5％),左右肝74例(37.9％)。主要狭窄分布:肝门5例,右肝管22例,左肝管31例,乳头部狭窄8例。根据肝内结石状况和病理类型,分别采用不同的手术方法,肝叶切除96例,各类胆肠“Y”式吻合79例,残石率11.3％,无死亡。随访1年～9年,随访率86.2％,优良率96.4％。作者认为,在术前详尽的影像学检查的前提下,运用术中B超监测,肝叶切除及合理选用不同术式,可明显降低残石率,提高手术质量。

The authors' experiences with diagnosis and treatment from 195 cases of intrahepatic bile duct stones (IBDS) were reported. Following diagnostic measures were applied : uetrasonography (US), PTC,Intraoperative ullfrasonography, (IOUS) ,choledochoscopy. Location of stones were:in the left hepatic 85 cases (43. 5%) lobe;36 cases (18. 46%) in the right hepatic lobe;74 cases (37. 94%) in both lobes. Site of stricture were 5 cases:in hilar confluence of both hepatic ducts and common hepatic duct 22 cases in RHD, 31 cases in LHD and 8 cases in the region of ampulla of Vater. According to the status and pathological feature of the intrahepatic bile duct stones,different operative methods were performed including hepa-tectomy(96 cases)and various types of cholangioenteros tomy(79 cases). Good ressults were acineved. The residual stone rate was 11. 28%, There was no the operative mortality. Patients have been followed up from 1 to 9 years. Follow up rate was 86. 15%,good result 96. 44% was obtained. The authors concluded that under the scrutiny into preoperative imaging studies and IOUS monitor,with proper application of hepatec-tomy and appropriate combination of different operative procedures, the rate of retained stones could be obviously reduced and operative quality greately was improved.