肝内胆管结石468例的诊治

Diagnosis and treatment of hepatolithiasis: report of 468 cases

目的 总结肝内胆管结石的临床经验。方法 回顾分析了468例肝内结石病人的诊断方法。手术方式、并发症。结果 由于坚持专业人员参与术前B超+术中B超检查,纤胆镜检查取石,术后胆镜取石的贯序治疗,使病人出院时残石率为8.1％,取得了优异的疗效。结论 （1）专业人员参与术前B超检查是有益的;（2）术中B超检查、监督、引导取石是术中不可缺少的重要工具;（3）切除含病灶的肝叶是治疗肝内结石的有效手段;（4）术后胆镜取石是进一步降低残石率的好方法。

Objective To review the clinical experience in diagnosis and treatment of hepatolithiasis. Methods The clinical data of 468 patients with hepatolithiasis admitled to our hospital were analyzed retrospectively. Results Owing to the pre- operative BUS, IOUS (intraoperative ultrasonography scanning) and choledochofiberscopy during the operation by skilled surgeons, the rate of residual stones in the patients with hepatolithiasis was reduced to 8. 1 % and there is no operative mortality. Conclusions Four factors may play important roles in reducing the rate of residual stone, (1) Preoperative examination by surgens is very helpful. (2) IOUS was essential in the operation. (3) Hepatee-tomy was the most effective treatment for hepatolithiasis in the process. (4) Choledochoflberscopy examination is also effective in reducing the rate of residual stones.