肝胆管结石外科治疗的术式选择与疗效观察

目的探讨肝胆管结石外科治疗的术式选择与疗效。方法选取我院2010年3月至2013年3月肝胆管结石120例病例资料,其中行肝内胆管探查取石术43例;肝部分切除术37例;肝胆管成形术加胆肠吻合术31例;纤维胆道镜取石术9例。回顾性分析不同手术方式的临床疗效。结果术后1~10年的随访,统计分析后发现不同手术之间的术后残石率、术后优良率、术后并发症发生率分别为:肝内胆管探查取石术(42.23%、78.69%、9.23%),肝部分切除术(8.05%、95.93%、18.09%),肝门部胆管成形加胆肠吻合术(13.33%、87.33%、21.32%),纤维胆道镜取石术(31.98%、78.04%、15.69%)。术后总残石率24.17%、总优良率85.83%、术后并发症发生率15.83%。结论根据患者的病史选择合理的手术方式,能降低患者残石率和术后并发症发生率,并提高术后优良率。

Surgical treatment choice of hepatolithiasis and its curative effect

Objective To analyze the surgical treatment choice of hepatolithiasis and its curative effect. Methods The clinical data of 120 patients with hepatolithiasis admitted in our hospital were randomly selected and retrospectively analyzed. 43 cases were undergone cho- ledoeholithotomy, 37 cases were given merotomy of live, 31 cases were given hepatic duct plasty and choledochojejunostomy, and 9 cases were performed fiber choledochoscope lithotomy. Results All the 120 cases were followed-up from 1 year to 10 years. The postoperative re- sidual stone rate, good rate, and occurrence rate of complications were respectively： 42.23%, 78.69% , 9.23% in group of choledocho- lithotomy; 8.05%, 95.93%, 18.09% in group of merotomy of live; 13.33%, 87.33%, 21.32% in group of hepatic duct plasty and cho- ledochojejunostomy; 31.98% , 78.04%, 15.69% in group of fiber choledochoscope lithotomy. The total residual stone rate was 24.17%, the total good rate was 85.83% , and the occurrence rate of complications was 15.83%. Conclusion Choose the suitable operation method according to medical history of patients is the the key to reduce the residual stone rate and the occurrence rate of complications, thus elevating therapeutic efficacy of hepatolithiasis.