肝内胆管结石的外科治疗（34年1448例总结）

目的：探讨肝内胆管结石外科治疗的方法及适应证选择。方法：总结分析1964－1997年手术治疗肝内胆管结石1448例。根据结石的部位、分布、数量、大小和肝胆系统的病理变化状况分别选择不同术式或联合手术,配合使用纤维胆管镜取石、碎石等综合措施。结果：平均3年以上的随访效果：局部性肝叶、段胆管结石、行肝切除,优良93．8％,多发肝胆管结石并狭窄,行肝胆管空肠吻合,优良88．7％,肝切除与肝胆管空肠吻合联合手术,优良91．1％,胆总管十二指肠吻合,优良70．85,不伴胆管狭窄者,行胆道探查胆道镜取石,优良88．5％,单纯胆道探查器械取石,优良65．1％,结论：利用现代影像技术。良好的胆系造影,明确并根据结石和肝、胆管系统的病理状况,分析选择不同术式或联合手术,配合胆道取石等综合措施,有利于提高疗效。     

Extracorporeal ultrasonic lithotripsy of biliary calculi]

The article analyses the efficacy of extracorporeal lithotripsy by a LT-01 piezoelectric lithotriptor (EDAP, France). A total of 72 lithotripsy sessions were performed on 37 patients, in 2 of them who suffered from chronic calculous cholecystitis the procedure was conducted on the day before the operation. As a method for treatment, extracorporeal lithotripsy was applied in 35 patients for the following indications: solitary and multiple stones measuring in sum no more than 3 cm in the satisfactory functioning of the gallbladder and patency of the bile ducts. In 35 patients the stones were crushed to fragments of various size. In 29 patients extracorporeal lithotripsy produced a marked effect and was the final method of treatment. Six patients were operated on (cholecystectomy) due to exacerbation of chronic cholecystitis in 4 patients, pancreatitis in one patient; total destruction of calcinated large stone fragments could not be achieved after 6 sessions in one patient.     

复杂性肝内胆管结石的外科治疗

目的　总结复杂性肝内胆管结石的外科治疗方法及效果。 方法　 总结分析１９９２ ～１９９８ 年外科治疗复杂性肝内多段胆管结石并多处胆管狭窄３５ 例的手术方法,总结显露与切开肝内狭窄段胆管、取出结石、解除狭窄的经验和体会。 结果　３５ 例无手术死亡,术后近期并发感染、胆漏、肝功能不全或消化道出血共７ 例,均治愈;残留结石９ 例,术后经胆道镜取净结石７ 例。随访６ 个月至５ 年６ 个月２４ 例,优良２１ 例（８８ ％ ） ,好转２ 例（８ ％ ） ,无效１ 例（４ ％ ） 。 结论　复杂肝内胆管结石外科治疗的关键是显露和切开肝内各叶段胆管的狭窄段,取出结石、建立通畅的胆流通道。经肝门区或肝方叶可以显露和切开肝门胆管、左右肝管和左内叶、右前叶胆管,经肝膈面切开肝实质进路,可以显露和切开右肝内各叶段胆管。     

Reoperation versus alternatives in retained biliary calculi

Retained common bile duct stones can be treated by operation, dissolution, extraction, fragmentation, papillotomy, and reoperation. Each approach requires some expertise, and the likelihood of success of most depends on the composition and size of the stones. Good results often can be obtained nonoperatively, especially with a multidisciplinary team. Reoperation is rarely necessary.     

Extracorporeal lithotripsy in the treatment of biliary calculi

The authors present their experience from February 1988 with biliary lithotripsy in 125 patients. They review the protocol inclusion criteria and the various forms of complementary medical treatment. From this group, 30% of the patients underwent cholecystectomy, 45% received medical treatment and only 25% did not eventually require complementary medical therapy.     

纤维胆道镜在肝胆管结石中的临床应用

目的:探讨纤维胆道镜在肝胆管结石术中、术后的应用价值。方法:回顾性总结纤维胆道镜探查取石46例,其中开腹术中取石13例,联合腹腔镜术中取石25例,术后经T管窦道取石8例。结果:本组46例用纤维胆道镜探查取石效果满意,术后造影正常,无残余结石。结论:术中应用纤维胆道镜探查取石可降低残余结石的发生率,经T管窦道取石是治疗术后残余结石最安全有效的方法,避免了再手术的痛苦。