肝胆管结石的外科治疗方式与疗效

The result of surgical therapy for hepatolithiasis

目的 评价肝胆管结石的外科治疗方式与疗效关系。方法 面询或问卷调查 10年间因肝胆管结石接受手术治疗的病例。按术式分组比较其临床疗效。结果 10年间因肝胆管结石接受手术治疗者 85 9例 ,随访 5 37例 (占 6 2 5 % ) ,手术至随访时间 4年 7个月～ 11年 6个月 (平均 8年4个月 )。T管引流、胆肠吻合、联合肝段 /叶切除术式术后胆管炎复发率分别为 48 6 %、2 2 7%和2 0 4% (χ2 =42 0 ,P <0 0 1) ;再手术率分别为 31 2 %、8 8%和 2 9% (χ2 =5 6 5 3,P <0 0 1)。结论病灶是否去除是影响肝胆管结石远期疗效的主要因素 ;治疗肝胆管结石只要能达到充分解除胆道狭窄、梗阻 ,切除纤维化萎缩肝段等治疗目的 ,都能起到减少结石。

Objective To evaluate the effect of surgical therapy for hepatolithiasis. Method Postoperative patients were followed up by interview and questionaire with reference to the effect of surgical therapy. Result During the past 10 years, 859 patients with hepatolithiasis underwent exploration plus T tube drainage, hepatojejunostomy or combined hepatic segmentectomy, 537 cases were followed up for an avarage of 8 years and 4 months. The postoperative recurrence rate of cholangitis was 486%, 227%, and 204% respectively (χ2=420, P<001), and re-operation rate was 312%, 88% and 29% respectively (χ2=5653, P<001). Conclusion Patients undergoing combined hepatic segmentectomy and hepaticolithotomy have the best results for the removal of the focus.