手术治疗肝胆管结石198例临床效果分析

CLINICAL EFFECTS OF OPERATION ON THE 198 PATIENTS WITH INTRAHEPATOLITHIASIS

目的 探讨肝段切除与胆管切开取石术治疗肝内胆管结石的效果。方法 对 198例肝内胆管结石的手术治疗进行分析。全部病例分为 2组 ,一组采用肝段切除为主的联合手术 90例 (下称肝段切除组 ) ,另一组采用胆管切开为主的联合手术 10 8例(下称胆管切开组 )。结果 随访肝段切除组优良率为 92 .5 4% ,胆管切开组优良率为 6 8.6 1%。肝段切除组较胆管切开组术后残石率低 (8.96 % :2 7.91% ,P<0 .0 5 ) ;症状复发率低 (13.43 :32 .5 6 ,P<0 .0 5 ) ;再手术率低 (0 :10 .47 ,P<0 .0 5 )。结论 肝段切除为主的联合手术能有效降低术后残石发生、症状复发和再手术率 ,是当前治疗肝胆管结石的首选术式。

Objective To evaluate the effects of surgical treatment with hepatic segmentectomy or with bile duct stone removal in patients with intrahepatic cholelith.Method 198 cases of intrahepatic cholelith with operation were reriewed.Patients(90 cases) were treated hepatic segmentectomy and the other (108 cases)with bile duct stone removal.Results Follow-up results showed the rate of good treatment in first group was 92.54%,and second group was 68.61%.The rates of residual stone,symptom recurrence,and reoperation were 8.96% vs 27.91%(P<0.05),13.43% vs 32.56% (P<0.05),and 0% vs 10.47%(P<0.05),respectively.Conclusions In case of intrahepatic cholelith complicated by bile duct stricture surgery combined with hepatic segmentectomy should be the therapy of chlice.