肝胆管结石的系列治疗

目的 研究系列治疗在肝胆管结石治疗中的作用与地位。方法①系列治疗前各项影像学检查、胆道镜检查,了解肝胆管结石的数量、分布,有无肝胆管狭窄存在及程度、肝萎缩范围。②术前系列治疗:驱蛔治疗、消炎利胆药物使用、经T管胆道冲洗、经T管瘘道胆道镜治疗。③手术与术中系列治疗:以手术为主体,同时采用术中胆道镜、术中胆道造影等措施发现并去除结石、病灶。④术后系列治疗:术后胆道镜,术后经胆道外引流管射流震荡冲洗,持续灌注冲洗,溶石液溶石治疗。结果 术中胆道镜等系列治疗应用后使手术残石率由79％（314/398）降低为24％（96/398）,经术后胆道镜等系列治疗后,最终残石率降低为2％（19/786）。结论①只有采取系列性治疗措施,才能根本改善肝胆管结石的疗效。②胆道镜外科技术在系列治疗中发挥着至关重要的作用。③必要的术前检查使术者在术前对手术的难度即有充分的估计,必要的术前治疗可使手术的难度降低,应尽量避免急诊手术。

Clinical analysis of the role of the systemic therapy in hepatolithiasis

Objective To study the methods and value of systemic therapy in hepatolithiasis. Methods A total of 786 patients with hepatolithiasis were treated with systemic therapy from Nov. 1981 to Dec. 2000. And put forward systemic therapy and the method to apply choledochoscopy to surgery. Before systemic therapy the quantity and distribution of hepatolithiasis, the existence and severity of the stricture of hepatic duct, and the range of hepatic atrophy were determined by imaging examination. Pre - operative systemic therapy included removing roundworms, eradicating inflammation and normalizing function of the gallbladder, douching biliary tract through T- tube. Foci were identified by intra-operative choledochoscopy (IOC) and imaging examination of biliary duel, stones were removed during the cousse of operation with operation as the main treatment method. Post - operative serial therapy involved using post - operative choledochoscopy (POC), douching bile duct through external drainage tube and treating with stone - dissolving solution. Results The application of IOC decreased the residue stone rate from 79% (314/398) to 24% (96/398), the final residue stone rate was reduced to 2% (19/786) after serial therapy with POC. Conclusions Only by taking measures of serial therapy can the therapeutical effect of hepatolithiasis l>e fundamentally improved. Choledochoscopy technique plays a vital role in serial therapy.