肝内胆管结石的外科治疗：附119例病例分析

目的探讨肝内胆管结石外科治疗方法的选择及疗效。方法对我院2005年6月～2010年6月经手术治疗的肝内胆管结石119例的临床资料进行回顾性分析。结果本组均行手术治疗,其中行肝叶切除术43例,肝叶（段）切除、胆管空肠Roux-en-Y吻合术35例,胆管空肠Roux-en-Y吻合术26例,胆管切开取石、T管引流术15例。本组术后残余结石12例（10.08%）,再手术9例（7.56%）。术后随访5～36个月,全组优良106例（89.08%）,差13例（10.92%）。结论采取合理的手术方式解除胆道梗阻,去除病因,术中及术后配合胆道镜取石可减少结石残留及复发,避免二次手术。

Surgical Treatment of 119 Cases of Hepatolithiasis

Objective To explore the clinical curative effect of different surgical procedures in treatment of hepatobiliary tract stones.Methods The clinical data of 119 cases of hepatolithiasis undergoing surgical treatment during 2005 and 2010 in our hospital were retrospectively analyzed.Results All the patients underwent surgical treatment,including 43 cases of the liver lobectomy,35 cases of hepatic lobe resection(segment),Roux-en-Y bile duct jejunum anastomosis,26 cases of bile duct Roux-en-Y anastomsis,15 cases of bile duct incision to take stone,T tube drainage.12 cases(10.08%) had residual stones,9 cases(7.56%) underwent reoperation.All patients were followed up for 5 months to 3 years.The overall sufficient or complete remission rate was 89.08%,and the poor efficacy rate was 10.92%.Conclusion A reasonable surgical approach to remove the obstruction,and to remove the cause of the disease in addition to intraoperative and postoperative cholangioscopy is helpful in reducing residual stones and recurrent stone,and avoiding the second surgery.