关于肝胆管结石的外科治疗中的几个问题

Problems related to the surgical treatment in hepatolithiasis

目的 评价外科手术在肝胆管结石治疗中的作用。方法 对肝胆管结石外科治疗中应注意的问题进行评述。结果与结论 术前必须行胆道造影 ,以了解病变的部位和范围 ;应根据结石的部位、范围、有无合并症及病人情况选择手术方式 :肝切除是对肝胆管结石进行合理治疗的必要手术 ,选用胆肠吻合术要严格掌握手术指征 ;术中应用B超、胆道造影及纤维胆道镜 ,有利于发现和处理残留结石 ;术后应常规行经T(U)管胆道造影 ,如发现残石可行纤维胆道镜取石 ;对合并门静脉高压症者 ,一般采用分期手术。

Objective To evaluate the effect of surgery in the treatment of hepatolithiasis. Methods Assessment of the problems concerning surgical treatment in hepatolithiasis. Results and Conclusions (1) cholangiography was adopted to know about the location and extension of hepatolithiasis before operation; (2) selection of the operative procedure should be done according to the location and extension of the disease, complications and patients's condition: hepatectomy is a basic and rational procedure for hepatolithiasis; the indications of cholangioenterostomy must be restricted; (3) intraoperative ultrasounography, cholangiography and cholangioscopy are useful to find and manage the residual stones; (4) postoperative cholangiogray via T(U) tube should be done, if residual stone is found, removing the stone through cholangioscopy can be reached; (5) generally stage operation should be considered, if the patient is complicated with portal hypertension.