156例肝胆管结石病手术患者的临床分析

目的总结肝胆管结石病外科手术治疗的临床经验,探讨最佳治疗方法。方法回顾性分析156例肝胆管结石病患者手术治疗的临床资料,包括术式选择、治疗效果、术后并发症及残石情况。156例中肝部分切除术64例,肝胆管切开取石＋T管引流术42例,肝胆管切开取石＋胆肠吻合内引流术34例,肝门部胆管切开成形＋肝胆空肠Roux-en-Y术16例。结果132例患者得到随访,随访时间为术后6个月～5年,术后治疗效果优良率及结石残留率肝部分切除术分别为90.74%和7.41%,肝胆管切开取石＋T管引流术分别为72.22%和33.33%,肝胆管切开取石＋胆肠吻合内引流术分别为72.41%和27.59%,肝门部胆管切开成形＋肝胆管空肠Roux-en-Y术分别为84.62%和30.77%,总优良率为81.06%,结石残留率为21.21%。结论应用现代诊疗手段,对病情作出正确判断,选择合理的手术方式,是提高肝胆管结石病治疗效果的关键。肝叶段切除术可明显减少结石的残留和复发率,是治疗肝内胆管结石的重要方法。

Clinical Analysis on 156 Operative Patients with Hepatolithiasis

Objective To summarize the clinical experience of surgical treatment and to find the best therapy in hepatolithiasis. Methods To retrospectively analyze the clinical data of surgical treatment of hepatolithiasis in 156 patients, including operation mode selection, effects, postoperative complications and residual stone situation. Among all the operative patients, there were 64 cases of lobectomy of liver, 42 cases of choledocholithotomy with T-tube drainage, 34 cases of eholangiojejunostomy with T-tube drainage and 16 cases of plastic repair of hepatic portal duct with cholangiojejunostomy. Results 132 cases were followed up from 6 months to 5 years. After operation, the superior rate and residual stone rate were respectively 90. 74%,7.41% in lobectomy of liver, 72.22%, 33.33% in choledocholithotomy with T-tube drainage, 72. 41%, 27.59% in cholangiojejunostomy with T-tube drainage, 84. 62%, 30. 77% in plastic repair of hepatic portal duct with cholangioje-junostomy. The total superior rate was 81.06%, and the total residual stones rate was 21.21%. Conclusion It is the key to elevate the therapeutic efficacy of hepatolithiasis to utilize modern diagnosis and treatment means, exactly judge disease condition and choose reasonable operation mode. For most patients with hepatolithiasis, lobectomy of liver can get good therapeutic effect and significantly reduce the residual stones and recurrence rate of hepatolithiasis, which is an important method to treat hepatolithiasis.