肝叶、段切除术治疗复杂肝内胆管结石

Treatment of Complex Intrahepatic Biliary Calculi with Hepatic Lobectomy or Segmentectomy

目的 :总结肝内胆管结石手术治疗的方法及疗效。方法 :回顾性分析经手术治疗的 145例肝内胆管结石的临床资料。结果 :区域性肝切除组术后优良率明显高于未切肝组 ,且残石率低。而切肝组中胆肠引流组术后优良率也明显高于胆总管切开取石引流组 ,残石率也低。单纯胆总管切开取石引流组术后优良率低而残石率高。结论 :区域性肝切除加肝内胆管与空肠引流疗效最佳 。

Objective: To evaluate the mothod and result of surgical operative treatment for intrahepatic biliary calculi. Methods: The clinical data of operative treatment for 145 cases with complex intrahepatic biliary calculi were reviewed. Results: The postoperative excellent rate of the partial hepatectomy was higher and residual stones was lower than that of the nonhepatectomy. The postoperative excellent rate of the partial hepatectomy with Roux-en-Y hepatico-jejunostomy was higher than that of the choledochotomy with T-type drainage and the rate of the residual stones was lower. The postoperative excellent rate of the choledo-chotomy with T-type drainage was not only lower but also the rate of the residual stones was higher. Conclusion: Our experience suggests that the therapeutic result of the partial hepatectomy with hepatico-jejunostomy is the best and that of the choledochotomy with T-type drainage is the worst.