肝内胆管结石术后复发的再处理

Management of recurrent stones in patients with hepatolithiasis after surgery

肝内胆管结石术后复发是肝内胆管结石手术后最常见的并发症,其再处理方法是当今胆道外科最为棘手的问题之一.目前临床上处理方式很多但大部分患者远期效果并不能令人满意.非手术方法包括溶石、碎石、取石等.手术方法有肝实质切开取石、肝叶(段)切除、胆肠吻合术及肝移植等.其中肝叶(段)切除及肝移植能一次手术完成肝胆管结石外科治疗原则要求的彻底的根治性手术.应该根据每个患者的具体情况制定个体化的治疗方法.

Recurrent stones is a common postoperative complication in patients with hepatolithiasis and is hard to treat. There are many treatments available to treat recurrent stones, but satisfactory results can be achieved in few patients. Nonsurgi- cal treatments include the dissolution of stones, extrahepatic lithotripsy, and stone removal with- out surgery. Surgical treatments include hepatoli- thectomy, hepatic resection, hepatico-jejuno anas- tomosis, and liver transplantation. Hepatic resec- tion and liver transplantation are radical surgery for recurrent stones. Personalized retreatment should be adopted for recurrent stones according to the conditions of each patient.