237例肝内胆管结石的手术治疗随访

Follow up Observations on 237 Operative Patients with Intrahepatic Cholelithiasis

对237例肝内胆管结石手术治疗病人作了随访和分析,随访期1～5年,效果满意。手术原则是:(1) 显露1～3级胆管;(2) 尽可能取尽结石;(3) 矫治胆管狭窄;(4) 切除无功能的病灶肝叶或段;(5) 根据情况建立大口径胆肠吻合或者单纯肝外胆管T管引流。认为取得良好的手术治疗效果的关键是彻底清除肝内病灶。

Two hundred and thirty-seven operated patients with intrahepatic cholelithiasis were followed up and analysed. The follow-up period was 1～5 years and satisfactory effect was obtained in this series. The operative prinicples were: 1.Exposure of the 1st～3rd order bile ducts, 2. Removal of the cholelithiasis as through as possible, 3. Correction of the strictured bile ducts, 4. Resection of the impaired functionless hepatic lobe or segement, 5. Reconstruction of the adequated bile drainage with a wide stoma bilioenterostomy or simple T tube drainage of the extrahepatic bile duct according to necessity. It was stressed that the key point of surgical treatment was completely removing intrahepatic impaired focuses. The indications and surgical details of bile intestinal by-pass were also discussed.