肝内胆管结石的手术治疗

Surgical treatment of intrahepatic cholelithiasis

目的 探讨肝内胆管结石并狭窄的手术治疗方法及其效果。 方法 回顾性总结了 1990年 1月～ 2 0 0 2年 1月间16 3例肝内胆管结石并胆管狭窄的外科手术治疗情况。 结果 16 3例其中行肝叶切除 5 9例 ,胆总管切开取石 +T管引流 5 3例 ,胆总管切开取石 +U形管引流 5例 ,胆肠吻合 +肝叶切除或胆总管取石 92例。肝门部肝胆管狭窄整形 6 6例。术后残留结石 31例 ,术后经胆道镜取石 16例 ,其余 15例中有 7例再次手术行肝叶切除治愈。有 18例术后常有上腹隐痛或发烧。 结论 肝内胆管结石并狭窄常需要联合手术治疗 ,去除病灶 ,解除梗阻 ,畅通引流是外科的治疗原则。三者缺一不可 ,肝内胆管结石的病人常常有不同程度的肝叶纤维化、肝萎缩和肝胆管狭窄并存。手术必需切除病变肝叶 。

Objective To investigate the surgical measurement and effect of patients with intrahepatic cholelithiasis and biliary stricture. Methods A clinical retrospective study was made on 163 patients with cholelithiasis and biliary sricture. Results Among them 59 cases were subjective to hepatectomy, 53 cases to choledochotomy plus T tube drainage, 5 cases to choledochotomy plus U tube drainage, 92 cases to hepatectomy, cholangiotomy and biliary enteric anastomosis, 66 cases to plastic operations of the hepatic duct stricture. In 31 cases residual stones were found and the residual stones of 16 cases were removed by fiber biliary endoscopy, 7 cases received hepatectomy. After operation 18 cases complained of upper abdominal pain and fever. Conclusions The patients with hepatolithiasis were complicated with local hepatic atrophy and biliary stricture. Partial hepatectomy, plastic operation of biliary stricture, combined with biliary enteric were effetive ways to treat hepatolithiasis with biliary stricture.