肝内胆管变异合并结石的外科治疗

目的 探讨肝内胆管变异合并结石的外科治疗方法和作用。方法 1986年6月至1997年6月采用4种术式治疗54例肝内胆管变异合并结石病人：（1）变异肝管开口原位整形术12例；（2）变异肝管与相邻肝管开窗术9例；（3）变异肝管与相邻肝管合干成形术14例；（4）变异肝管相应肝段、叶切除术19例。结果 7例发生术后并发症，均经非手术治疗治愈。全部病人随访4－15年（平均8．9年），胆道残余结石率24．1％，疗效优良率83．3％。1992年12月以来，9例胆道残余结石病人行纤维胆道镜取石，6例取尽。结论 准确定位诊断和合理的手术方法治疗肝内胆管变异合并结石可获得较满意的结果。

Surgical treatment of biliary duct variation with hepatolithiasis

Objective To investigate the role and method of surgical treatment for biliary duct variation with hepatolithiasis. Methods The clinical data of 54 patients with biliary duct variation with hepatolithiasis treated in our hospital from June 1986 to June 1997 were retrospectively analyzed. The operations were divided into 4 types: 1) In situ cholangioplasty of variant hepatic duct in 12 patients. 2) Fenestration of variant hepatic duct and adjacent hepatic duct in 9 patients. 3) Coalescence of variant hepatic duct and adjacent hepatic duct in 14 patients. 4) Lobectomy or segmentectomy of variant hepatic duct in 19 patients. Results In hospital complications including postoperative infection, biliary fistula and adhesive intestinal obstruction occurred in 7 patients and were conservatively cured. There was no perioperative death. The follow up of 54 patients for 4 to 15 years showed that the excellent rate was 83.3% and residual stone rate 24.1%. Residual stones were removed through cholangioscopy in 6 of the 9 patients. Conclusions Accurate topical diagnosis and appropriate operation can acquire satisfactory results in treatment of biliary duct variation with hepatolithiasis.