肝胆管结石并胆管狭窄的手术治疗体会

目的探讨肝内胆管结石并胆管狭窄的手术治疗方法。方法选择2006年5月～2010年12月住院治疗的肝内胆管结石并胆管狭窄患者46例,行肝叶(段)切除术、胆管狭窄切开整形、胆管空肠Roux-en-Y吻合术等治疗。结果所有患者均无手术死亡。术后随访1～4年,2例出现切口感染,2例出现胆漏,均经保守治疗治愈,手术优良率91.30%。术后残余结石3例,残石率6.52%。结论肝内胆管结石并胆管狭窄患者选择合理的手术及术中正确判断、处理取净结石,可提高治愈率,降低结石残余率,是治疗此病症的有效治疗手段。

Objective To explore the surgical method for treatment of intrahepatic bile duct stones with bile duct stenosis. Methods 46 cases of bile duct stones with bile duct stenosis admitted to our hospital from May, 2006 to Dec, 2010 were selected and received operation such as hepatic lobe （segment） resection, eholangiotomy and plasty, and Roux-en-Y hepaticojejunostomy etc. Results All patients were alive after operation. After follow-up for one to four years, two cases with wound infection, 2 cases with bile leakage, are cured after conservative treatment. The excellent and good rate was 91.30%. Residual stones in three cases, the residual rate of 6.52%. Conclusion Rational procedure and correct judgment in operation can improve the cure rate and reduce the residual stone rate, which is an effective method for the treatment of intrahepatic bile duct stones with bile duct stenosis.