手术治疗肝内胆管结石163例报告

目的 总结肝内肝管结石并狭窄性病变诊治的经验。方法 回顾性分析163例肝内胆管结石并狭窄性病变的临床资料。结果 162例获临床治愈,死亡1例,手术病死率为0.6%。发生切口感染及裂开、肺部感染等并发症6例,残余结石9例。40例行钡餐检查,无一例钡剂越过人工防返流装置,随访126例（77.30%),随访时间6月-5年,优良组112例（88.9%);良好组11例（8.7%)。不良组2例（1.6%),均经再次手术矫正,1例胆管空肠Y吻合术后8个月出现人工套叠坏死再次手术行肠坏死切除肠吻合治愈。结论 肝内胆管结石并狭窄手术处理以矫治狭窄并行间置空肠肝胆管盆十二指肠吻合术疗效最确切,局限于左侧肝胆管狭窄及结石伴有肝实质损坏者。施行左肝叶切除术为佳。

SURGICAL TREATMENT OF HEPATOBILIARY CALCULUS STONES(A REPORT OF 163 CASES)

Objective To summarize the experience of diagnosis and treatment of hepatobiliary calculus stone and stricture. Methods The authors conducted a retrospective chart review of documented hepatobiliary calculus stone date.Results 162 cases were recovery.There was 1 death with mortality of 0.6%.There were 6 complications.Residue calculus stone was found in 9 cases.40 patients underwent barium meal examination,without the device of influx.126 patients were followed-up(77.3%),from 6 months to 5 years.112 cases were in the excellent group,11 cases in the good and 2 cases in the bad one.2 cases underwent reoperative correction.1 case with choledochojejunostomy by artificial intussusception was cured after 8 months.Conclusion It is the most exact by correcting constriction and hepaticduodenostomy;by interposition of jejunal loop;by surgical treatment of hepatobiliary calculus stone.The best way is to remove left liver for the treatment of patients with local left sides hepatobiliary stricture and calculus stone with lesions of the liver.