肝内结石症再次手术之分析

Analysis of Re-Operation for Hepatolithiasis

目的 探讨肝内结石术后结石再发或再次手术与结石所在部位的关系 ,以建立其适当的手术治疗原则。方法 对我科 1990～ 1995年间行手术治疗的 2 2 6例 (男 94例 ,女 13 2例 )肝内结石病例作回顾性分析。结果 2 2 6例中接受再次手术 ( 2～ 4次胆道手术 )者 10 1例 (占 44.7% ) ,其中第一次手术未诊断出肝内结石 ,在院外仅施行胆囊切除术者 2 1例 ( 2 0 .8% ) ,行胆总管切开取石术 72例 ( 71.3 % ) ,有 6例 ( 5.9% )曾行左肝叶切除 ,2例 ( 2 .0 % )行胆管空肠吻合术。再次手术之死亡率为 5.0 % ( 5/ 10 1) ,而初次手术者为零。结论 一般肝内结石症手术方法是依其结石所在部位而定 ,若为原发性 (I型或IE型 )行肝叶切除为佳 ,可减少结石再发之困扰。但若为继发性 (IE型或IE型 )则考虑其它方法 ,一般而言 ,胆管空肠吻合术或胆总管末端切开术之适应病例渐减。肝内结石症之治疗方式是多样的 ,需了解肝内结石部位及分型 。

Objective To investigate the recurre nce of hepatolithiasis and re-operation and their relation to the location of i ntrahepatic stone. Methods Two hundred and twen ty-six patients of hepatolithiasis operated upon in the period of 1990-1995 wer e retrospectively analysed.Results Among those patients, there were 101 pa tients (44.7%) had previous operation for the gallstones disease s including cholecystectomy for gallbladder stones ( n =21, 20.8% ), choledocholithotomy ( n =72, 71.3%),liver segmentectomy ( n =6, 5.9%), and choledochojejunostomy ( n =2, 2.0 %). The operative mortality was 5.0% for the re-opera tion group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malig nant changes especially in primary hepatolithiasis (type I, or IE ), choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatoli thiasis, the complete information of biliary tract is needed for the choice of s urgical methods.