肝胆管结石640例外科治疗及随访结果分析

An analysis of results of surgical treatment and follow up of 640 patients with intrahepatic bile duct lithiasis

目的 探讨肝内胆管结石手术疗效及其影响因素。方法 总结了 1984年 6月至 1998年 12月手术治疗的肝内胆管结石 6 40例。其中左肝管、右肝管和左右肝管结石分别为 2 6 9例(42 1% )、12 4例 (19 3% )和 2 47例 (38 5 % )。 35 7例合并胆管狭窄 ,占 5 6 0 % ,2 76例行肝叶或肝段切除术治疗 ,占 43 1%。结果 手术死亡 14例 ,手术病死率为 2 2 %。术后残石率 2 9 8%。肝切除术后残石率 (7 8% )明显低于胆道探查组 (6 9 3% ) ,差异有非常显著意义 (P <0 0 0 5 ) ,左肝管术后残石率明显低于右肝管或左右肝管 ,差异有非常显著意义 (P <0 0 0 5 )。 5 16例获 0 5～ 5年随访 ,优良率为87 4% ,397例获 6～ 12年随访 ,术后优良率为 82 1%。结论 肝切除术和自体组织修复术明显优于其他术式 ,左肝管结石的手术效果明显优于右肝管和左右肝管结石。还须指出 ,肝胆管结石的手术效果还与肝胆管结石的病变程度有关。

Objective To evaluate effect of surgical treatment in patients with intrahepatic cholelithiasis and analyze factors influencing operative treatment. Methods Altogether 640 cases of this disease treated from June of 1984 to December of 1998 were reviwed. Among them, left, right and bilateral hepatic cholelithiasis were respectively found in 269(42 1%), 124(19 3%) and 247(38 6%) cases. Out of them 357(56 0%) patients were complicated with bile duct stricture and 276(43 1%) were treated by lobectomy or segment hepatectomy. Results Fourteen (2 2%) patients died of surgery. The overall rate of residual stone was 29 8%. In the post lobectomy group the residual stone rate (7 7%) was significantly lower than that of the bile duct exploration group (69 3%) ( P<0 005 ) and in the left hepatic cholelithiasis group it was much lower than the right and bilateral groups ( P<0 005 ). During 0 5 to 5 years′ follow up of 516 patients the excellent and good result rate was 87 4%, and during 6 to 12 years′ follow up in 319 patients, it was 82 1%. Conclusions The method of lobectomy and repairing bile duct stricture with self tissue is better than other ones. The post operative excellent and good result of left hepatic cholelithiasis is superior to that of right or bilateral one and the surgical effect of intrahepatic cholelithiasis is influenced by the severity of the disease.