Ⅱa型肝胆管结石病外科治疗策略分析

Surgical strategies for type Ⅱa hepatolithiasis

】分析我院143例Oddi括约肌正常的Ⅱa型肝胆管结石病患者的临床资料。143例患者随机分为腹腔镜胆总管切开取石T管引流联合胆道镜取石组（A组，n=78）与腹腔镜肝部分切除联合胆道镜取石组（B组，n=65），比较两组患者的手术时间、住院天数、手术并发症发生率、术后残石率、结石复发率。分析表明，对于大部分Ⅱ。型患者采用A方案比B方案具有创伤更小、恢复更快、并发症更少的优势，两组患者术后残石率和结石复发率差异无统计学意义。但对于合并尾状叶结石的Ⅱa型患者，行A方案往往因肝总管与尾状叶胆管夹角过小导致胆道镜进镜困难，结石残留率高。因此，对于不同的肝胆管结石病患者，需依照结石的分布制定个体化方案。

The clinical data of 143 patients with type Ⅱa hepatolithiasis with normal function of the sphincter of Oddi were analyzed. The patients were divided into two groups at random. The data of the 2 groups of patients were compared on the operating time, hospitalization, rates of complication, residual stone rates and recurrence rates. The A group patients underwent laparoscopic video choledochoscopic hepaticocholangiolithotomy, T-tube drainage and choledochoscopic lithotomy. The B group patients underwent laparoscopic video hepatectomy and eholedochoscopic lithotomy. For most of the patients in the A group, the treatment had the advantages of less trauma, less complications and quicker recovery. There was no significant differences in residual stone rates and recurrence rates between the two groups. As it was difficult to remove stones in the caudate lobes of Ⅱa type patients in A group due to the sharp angle between the hepatic duct and bile ducts of the caudate lobe, individualized programs should be adopted according to the location of stones on individual patients.