肝切除联合术中纤维胆镜治疗肝胆管结石

目的 总结肝切除联合术中纤维胆道镜治疗肝胆管结石的疗效。方法 回顾分析我院经肝切除联合术中纤维胆镜治疗的54例肝胆管结石患者的临床资料。结果 手术死亡1例，术后重要并发症9例，包括胆瘘，膈下感染，肝功不全，胆道出血；残留结石4例，残留胆管狭窄3例，胆管细胞癌3例，随访8-78个月，结石复发5例，死亡5例（2例肝衰，3例胆管细胞癌），结论 肝切除联合术中纤维胆镜治疗肝胆管结石安全有效。且能消除胆管细胞癌发生的危险，优于传统手术，对肝硬化患者，是否行右肝切除应据患者情况而定。

HEPEATECTOMY COMBINED WITH INTRAOPERATIVE CHOLEDOCHOFIBERSCOPE FOR INTRAHEPATIC BILE DUCTS STONES

Objective To sum up the effects if hepatectomy combined with intraoperative choledochofiberscope for intrahepatic bile duct stones.Methods Clinical data of 54 paitnets with intrahepatic bile duct stones undergoing hepatectony combined with intraoperative choledochofiberscope in our hospital from March 1995 to January 2001 were analysed retrospectively.Results The operative mortality rate was 1.9%(1/54).The important postoperative complications occrred in 9 cases(16.7%),including transient biliary fistula(n=3),subdiaphragmatic infections(n=3),liver dysfunction(n=2),and hemobilia(n=1).The clearance rate of stones was 92.6%,the rate of remaining bile ducte stricture was 5.6%,and cholangiocellular carcinoma was found in 3 cases (5.6%).During the follow up period of 8 to 78 months(mean 38 months),stone reocurred in 5 cases(9.3%) and 5 cases(9.3%)died.Among them 2 cases died of liver failure,3 cases died of cholangiocellular carcinoma.Conclusions Hepatectomy combined with intraoperative choledochofiberscope is a safe and effective therapy for intrahepatic bile duct stones,and its superior to traditional sutgery.Also,the procedure can eliminate the risk of cholangiocellular carcinoma.Whether or not right lobe hepatic resection should depend upon the condition of patients with cirrhosis.