纤维胆道镜在肝内胆管结石外科治疗中的价值

Surgical treatment by using cholangioscopy for hepatolithiasis

目的 总结临床应用纤维胆道镜的经验 ,评价纤维胆道镜在肝内胆管结石治疗中的价值。方法 回顾总结手术治疗肝内胆管结石 2 799例 ,按是否配合使用纤维胆道镜的情况分 3组分析研究 :A组 2 0 7例 ,仅切开肝外胆管器械取石 ,未配合使用纤维胆道镜 ;B组 10 5 1例 ,术中用器械取石 ,术后应用纤维胆道镜检查取残石 ;C组 15 4 1例 ,术前经良好的胆管造影 ,术中、术后应用纤维胆道镜取石。结果 术中未用纤维胆道镜检查取石的术后残结石率 39% ,术中应用纤维胆道镜检查取石的术后残石率 5 % ,术中和 /或术后均用纤维胆道镜取石的最后残石率 2 .5 4 %。平均 6年半随访的结果优良 :C组优于B组 ,B组优于A组 ,均经 χ2 检验P <0 .0 5。结论 胆道内镜技术与外科手术联合应用可有效降低肝内胆管结石术后残余结石率 ,提高治疗效果 。

Objective To summarize experience in intraoperative and postoperative cholangioscopic therapy for hepatolithiasis and evaluate its clinical value. Methods 2 799 patients with hepatolithiasis were divided into three groups (A, B and C groups) and analysed. In group A 207 patients without preoperative cholangiography were operated on only with traditional apparatus. In group B 1 051 patients were treated with traditional apparatus during operation combined with postoperative stone removal changioscopy. In group C 1 541 patients with preoperative cholangiography were treated with choledochofiberscope befor, on and after operation. Results In group A, B and C the residual stone rate was 39%, 5% and 2.45% respectively. The follow-up results of average 6 years showed that group C was superior to that in group B and the therapeutic effect in group A was the worst. There were significant differences (P<0.05). Conclusions Operation combined with stone removal by cholangioscopy can lower the postoperative residual stone rate of hepatolithiasis.