联合肝切除治疗肝内胆管结石并狭窄

目的探讨联合肝切除组合胆道手术治疗肝内胆管结石并狭窄的疗效。方法回顾性总结四年来联合肝切除组合胆道手术治疗肝内胆管结石并狭窄８２例，其中，肝左外叶切除６５例（７９．２７％），左半肝切除１２例（１４．６３％），右肝部分切除３例（３．６６％），左肝外叶＋右前叶下段切除１例（１．２２％）。结果手术后结石取净７８例（９５．１２％），术后纤维胆道镜取石３例，２例结石取净，总的结石取净率为９８．７８％（８０／８２），手术并发症７例（８．５３％），死亡１例（１．２２％），８１例术后随访１个月～４年，肝内结石复发３例（３．７０％）。结论联合肝切除组合胆道手术是治疗肝内胆管结石并狭窄的有效方法、联合肝切除必须掌握适应证，急症肝切除的并发症多且较严重，术后纤维胆道镜检查与治疗对诊治残余结石有重要意义。

Combined hepatectomy for intrahepatic cholelithiasis and biliary stricture

Objective To treat patients with cholelitheasis and biliary stricture with combined hepatectomywith biliary tract operation. Methods From Jan. 1994 to Dec. 1997, 82 patients with intrahepatic cholelithiasisand biliarg stricture were operated with combined hepatectomy. Among them 65 cases (79. 27% ) were subjectedto operation of outer left lobectomy, 12 cases (14. 63% ) of left hemi-hepatectomy, 3 cases (3. 66% ) of Partialright hepatectomy, and 1 case (1. 22%) of combined resectics of outer left lobe and lower segament of front-rightlohe. Results Seven cases (8. 53% ) suffered from complications with one of tham (1. 22%) died. The stones of78 cases (95. 12%) were removed completely during the operation, while the residual stones of other 3 cases wereremoved by fiber biliary endoscopy with 2 of them succeeded. Altogether 81 patients were followed up from 1 monthto 4 years, and in 3(3. 70% ) recurrent cholelithiasis was found. Conclusions The above said operation is aneffective way to treat cholelithiasis with biliary stricuture. The indicative symptoms of hepatectomy must be empha-sized when Conducting the operation. There are frequent and serious complications in emergent hepatectomy. Post- operative fiber biliary endoscopy is valuable for diagnosis and treatment of residual cholelithiasis.