肝内胆管结石的多模式治疗策略

目的：总结多种术式治疗肝内胆管结石的临床经验。方法：回顾性分析1997年6月至2003年6月收治的肝内胆管结石病患者68例；其中，肝部分切除术 胆道镜应用治疗57例(83．82％)；胆总管切开取石 胆道镜应用治疗11例(16．18％)；肝胆管狭窄切开整形胆肠吻合术 胆道镜应用治疗7例(10．29％)；肝部分切除联合胆肠内引流治疗4例(5．88％)。结果：手术后结石取净66例(97．06％)，术后胆道镜取石2例，1例取净，总的结石取净率98．53％(67／68)；手术并发症9例(13．24％)，无围手术期死亡；全部病人随访6个月至2年，肝内胆管结石复发1例。结论：以肝部分切除及胆道镜应用为主的多模式治疗策略是治疗肝内胆管结石的最佳方案。

Multimodal Approach to Hepatolithiasis

Objective: To sum up the clinical experience of the treatment of hepatolithiasis. Methods: A retrospective study was made in 68 patients with hepatolithiasis who had been treated with different kinds surgery operation from June 1997 to June 2003. Fifty seven patients (83.82%) were operated with hepatectomy combined with the application of fiber biliary endoscopy,11 cases(16.18%)with choledochotomy and taking stones combined with the application of fiber biliary endoscopy,7 cases(10.29%)with plastic of stenotic bile duct Roux-Y cholangiojejunostomy combined with the application of fiber biliary endoscopy,4 cases(5.88%)with hepatectomy combined with Roux-Y cholangiojejunostomy. Results: The stones of 66 cases(97.06%)were removed completely during the operation,while the residual stones of other 2 cases were removed by fiber biliary endoscopy with 1 of them succeeded. Nine patients were suffered from complication. All patients were followed up from 6 months to 2 years,and 1 case of recurrent hepatolithiasis was found. Conclusion: The multimodal approach relying mainly on hepatectomy and the application of fiber biliary endoscopy was a preferable treatment for hepatolithiasis.