肝胆管结石手术方法及疗效的临床分析

Clinical Analysis of Surgical Treatment and the Efficacy with Hepatolithiasis

目的:分析肝胆管结石不同的手术治疗方法及疗效。方法:回顾性分析我院2000年1月至2012年12月83例手术治疗的肝胆管结石患者的临床资料,包括术式选择、术后并发症、术后残石率、结石复发率等情况。其中45例患者采用肝叶或肝段切除术,19例采用肝胆管切开取石+胆管空肠Roux-en-Y吻合术(其中12例行肝门部胆管狭窄切开整形),8例采用肝胆管切开取石+T管引流术,11例腹腔镜+胆道镜取石+T管引流术。结果:出现术后并发症、术后残石率、结石复发率,肝叶或肝段切除术为(17.78%、8.89%、6.67%);肝胆管切开取石+胆管空肠R ouxen-Y吻合术为(21.05%、26.32%、21.05%);肝胆管切开取石+T管引流术为(12.50%、37.50%、25.00%);腹腔镜+胆道镜取石+T管引流术为(0%、18.18%、27.27%)。结论:肝叶或肝段切除不能降低术后并发症,但可明显减少结石残留及复发率,是目前治疗肝胆管结石重要的手术方式。而胆肠吻合内引流、胆管切开取石、胆道镜+腹腔镜取石等手术方法具有各自特点,肝胆管结石治疗应根据具体情况采取个体化治疗方案。

Objective To analyze different surgical treatment and the curative efficacy with hepatolithiasis. Methods The clinical data of 83 patients hospitalized for hepatolithiasis underwent surgi- cal treatment from January 2000 to December 2012 were analyzed retrospectively,including operation mode selection, postoperative complications, postoperative residual stone rate and calculi recur- rence rate situation.Among all the operative patients,there were 45 eases of lobectomy of liver,19 cases of choledocholithotomy＋bile duct-jejunum Roux-en-Y anastomosis （among 9 cases of plastic rear of hepaticportal duet）, 8 cases of choledoeholithotomy with T-tube drainage, 11 cases of laparoscopic＋choledochoscope litho- tomy＋T-tube drainage. Results The postoperative complications, postoperative residual stone rate,calculi recurrence rate, lobectomy of liver （17.78% ,8.89% ,6.67% ）; choledocholithotomy＋bile duct-jejunum Roux-en-Y anastomosis （21.05% ,26.32% ,21. 05% ）; eholedocholithotomy with T-tube drainage （12.50% ,37. 50% ,25.00%）; laparoseopic＋eholedochoscope lithotnmy＋T-tube drainage （0%,18.18%,27.27%）.Conclusoin Lobectomyofliver can＇t reduce postoperative complications,but it can obviously reduce the residual stons and recurrence rate,it is an important surgical treatment on hepatolithiasis.Bile duct-jejunum anastomosis drainage, choledocholithotomy and choledochoscope＋laparoscopic lithotomy still have their own characteristics on hepatolithiasis. Hepatolith treatment should be adopted according to the specific sit- uation individualized treatment plan.