复发及残余肝胆管结石的外科治疗

Surgical treatment for hepatolithiasis with recurrence and residue

目的 探讨复发及残余肝胆管结石的治疗效果。方法 对我院 1993年 6月～ 2 0 0 1年6月收治的 10 5例复发及残余肝管结石的结石部位、病理情况、手术方式、治疗效果及随访结果等资料进行回顾性分析。结果 根据结石分布部位及胆管狭窄程度等采取肝叶切除 (5 2 .4%,5 5 /10 5 )、肝段切除 (13.2 %,14/10 5 )、胆肠吻合 (2 4.8%,2 6 /10 5 )、Ⅰ～Ⅲ级肝管切开引流加胆总管探查 (9.5 %,10 /10 5 )。所有病例随访 6月～ 8年 ,彻底治愈者 79%(83/10 5 ) ,效果优良者 94.2 %(99/10 5 )。结论 对于复发及残余肝胆管结石患者 ,应根据结石的部位、狭窄的程度等采取相应的治疗方法。肝叶及肝段切除是复发及残余肝胆管结石的较好外科治疗方法。胆肠吻合应掌握严格的适应证。Ⅰ～Ⅲ级肝管的多处切开引流加术中、术后胆道镜亦为有效方法之一。

Objective To evaluate the therapeutic effect of hepatolithiasis with recurrence and residue.Methods A retrospectively analysis was made on stones distribution, pathology, operation parterns, therapeutic effect and follow-up result in 105 patients with recurrence and residue hepatolithiasis from Jan. 1992 to Jan. 2000. Results Hepatic lobe resection ( 52.4%, 55/105), hepatic segment resection ( 12.4%, 13/105), cholangioenterostomy ( 24.8%, 26/105), cholangiotomy of Ⅰ to Ⅲ hepatic tube and choledochotomy ( 9.5%, 10/105) and intraoperative or postoperative cholangioscopy ( 80.9%, 85/105) were performed respectively on stones distribution and bile duct stricture. All cases were followed up after operation from 6 months to 8 years. 79% (83/105) of patients cured thoroughly and 94.2%(99/105) of patients had excellent and good results. Conclusions The treatment methods for recurrent and residual hepatolithiasis should be adopted in accordance with stones distribution and stricture degree of bile duct. Lobe and segment hepatectomy is effective method for recurrent and residual hepatolithiasis. The indications of cholangioenterostomy must be restricted. Cholangiotomy of Ⅰ to Ⅲ hepatic tube and intraoperative or postoperative cholangioscopy is also an effective measurement.