纤维胆道镜在肝内胆管结石手术治疗中的应用价值

The Value of Choledochofiberscopy in Surgical Treatment of Intrahepatic Bile Duct Lithiasis

目的：探讨纤维胆道镜在肝内胆管结石的外科手术治疗中的临床应用价值。方法：对我院１９８４ 年１１ 月～１９９８ 年６ 月间术后用胆道镜取石治疗肝内胆管残余结石２３３ 例作回顾性分析。结果：取净结石２１０ 例（９０．１％ ）；２３ 例残石未取净（９．９％ ），其中中转手术３ 例（１．３％ ）。影响术后胆道镜取石疗效的主要因素，包括手术时机、手术中是否作胆道镜检查、残留结石大小和嵌顿与否，以及肝内胆管是否狭窄。结论：在肝内胆管结石的外科手术治疗中，纤维胆道镜（包括术中和术后胆道镜）具有相当重要的临床应用价值。

Objective:To investigate the value of clinical application of choledochofiberscopy in surgical treatment of intrahepatic bile duct lithiasis.Methods:Two hundred and thirty three patients with retained gallstones in the intrahepatic bile ducts after choledochostomy were treated with choledochofiberscopy from November 1984 to June 1998 in this hospital.Results:In 210 cases(90.1%),the residual gallstones were thoroughly removed with choledochoscopy and in remaining 23 cases(9.9%),the stones were not completely removed,of whom 3 cases were reoperated on soon.The facters affecting the results of the procedures included the timing of operation,the performance of intraoperative choledochoscopy,the size of retained gallstones,the inlaid gallstones and the narrowed bile ducts.Conclusion:Choledochofiberscopy is of great value in surgical treatment of intrahepatic bile duct lithiasis.However,it can not completely replace hepatectomy to remove the damaged liver lobe caused by the gallstones.