规则性肝脏切除联合胆道镜治疗肝内胆管结石的疗效评价

The study on effectiveness of anatomic hepatectomy combined with choledochoscope for primary hepatolithiasis

目的探讨规则性肝脏切除联合胆道镜治疗肝内胆管结石的安全性和有效性。方法回顾性分析我院2012年1月至2017年12月间采用肝脏切除联合胆道镜治疗的65例肝内胆管结石患者的临床资料,评价其疗效。结果所有患者均顺利完成手术,手术时间170~330分钟,平均237.1±46.2分钟,术中常规切开胆总管行胆道镜探查取石,53例术中取净结石,术中结石清除率81.5%,术后12例结石残留,残留结石患者术后经1~4次胆道镜取石,11例成功取出,围手术期死亡术1例,术后随访6例结石复发。结论规则性肝脏切除联合胆道镜取石治疗肝内胆管结石安全有效疗,联合胆道镜有助于选择正确的肝脏切除范围,减少术后结石的残留和复发。

Objective To evaluate the effectiveness of anatomic hepatectomy combined with choledochoscope for primary hepatolithiasis.Methods The clinical data of 65 patients with hepatolithiasis were analyzed retrospectively.Results All patients undergoned operation successfully with the operative time 170~330 min,1 patients died post operation.The stones of 53(81.5%)patients were extracted clearly on operation,12 patients needed additional choledochoscope post operation.11 patients were extracted clearly finally.6 patients were recurrent post operation with a follow up from 3 months to 5 years.Conclusion Anatomic hepatectomy combined with choledochoscope is a safe and effective method for primary hepatolithiasis.