肝胆管结石并发复发性胆管炎时择期手术处理的关键

目的 探讨提高肝胆管结石并发复发性胆管炎病人治疗水平的方法。方法 报告3例肝胆管结石并发复发性胆管炎病人的手术中发现及胆树的主要梗阻部位。结果 例1是右后肝管与右前肝管汇入左肝管横部的胆管变异致右肝管狭窄继以结石形成、右肝叶萎缩；例2胆树的主要梗阻部位是肝尾叶结石及右肝动脉对肝总管的压迫性狭窄；例3总肝管狭窄及嵌顿结石是主要的梗阻部位，并采用了相应的手术方式治疗。结论 掌握影像诊断如BUS、CT、ERCP、MRCP提供的资料，术中仔细探查胆道，加上术中胆道镜运用，消除与胆管炎密切相关的主要梗阻是手术处理肝胆管结石并发复发性胆管炎病人的关键。

Key points of selective operation for hepatolithiasis associated with recurrent cholangitis

Objective To improve the efficacy of the treatment of hepatolithiasis associated with recurrent cholangitis. Methods The intraoperative findings and chief obstructive sites of the biliary tree in 3 patients with hepatolithiasis were reviewed. Results In case 1, an anatomical variation at the crosswise part of the left hepatic duct where the right posterior and right front hepatic duct converge caused obstruction of the right hepatic duct to result in stone and atrophy of the right hepatic lobe. In ease 2, the obstruction of the bile duct was mainly due to hepatolithiasis in caudate lobe and compressive stricture of the common hepatic duct caused by the right hepatic artery. In case 3, the stricture in the common hepatic duct associated with embedded stone were the chief reasons for obstruction of the biliary tract. Suitable operative approach was conducted, Conclusions Good command of image through BUS, CT, MRCP, ERCP and MRI etc. , careful intraoperative exploration of the biliary tree and use to intraoperative choledochoscopy to relieve chief biliary obstruction directly associated with cholangitis are important for treatment of hepatolithiasis associated with recurrent cholangitis.