肝切除术治疗肝内胆管结石36例临床分析

目的探讨肝切除术治疗肝内胆管结石的效果.方法对1991年9月-1997年12月肝切除术治疗肝内胆管结石患者36例进行分析,包括结石分布和胆道狭窄部位、手术方式、术后并发症及结石残留等.结果肝内胆管结石以左肝多见(22例),全肝结石其次(11例),22.2%同时存在胆道狭窄.肝切除以左外叶及左半肝切除为主(30例).8例行肝内狭窄胆管切开整形、胆管空肠吻合.5例出现手术后并发症.19.4%的病例有结石残留.治疗效果优良者占86.2%.结论肝切除术是治疗肝内胆管结石的主要方法,为减少结石的残留和复发,应根据情况同时行肝内狭窄胆管切开整形、胆管空肠吻合.

Hepatectomy for Hepatolithiasis Treatment of 36 Cases

Objective To evaluate the effect of hepatectomy for hepatolithiasis. Method 36 patients with hepatolithiasis underwent hepatectomy from September 1991 to December 1997. The results were analysed retrospectively, including distribution of stones, stricture of intrahepatic bile ducts, patterns of operation, postoperative complications, and residual stones. Result Left hepatolithiasis was the most common form (61. 1 % ). Left lateral lobectomy and left hepatectomy were most commonly employed (83: 3 % ) 22 .2 % of the patients underwent concurrent plasty of stenotic intrahepatic bile ducts and cholangiojejunostomy.19 .4 % patients had residual stones, and postoperative complications occurred in 5 patients. 86.2%the patients showed excellent or good result. Conclusion Hepatectomy is a major procedure for the management of hepatolithiasis, but still requires combined plasty of stenotic intrahepatic bile ducts and cholangiojejunostomy to reduce the incidence of residual stones and recurrence.