肝胆管结石外科诊治的临床研究

目的：总结肝胆管结石诊治的临床经验。方法：回顾性分析320例临床病例的定位诊断,术式选择,合并症,并发症及随访情况。结果：术前检查行B超检查320例（100％）,MRCP30例（9．4％）。合并胆管狭窄162例（50．6％）,胆管癌3例（0．9％）,行左外叶或左半肝切除253例（79．1％）,右叶各段切除39例（12．1％）,方叶切除20例（6．2％）,右半肝切除8例（2．5％）。术后并发症发生率20．4％,残石率19．8％,0．5－15年随访优良率87．5％。结论：（1）MRCP对肝胆管结石的术前定位诊断优于其他方法;（2）以切除含病灶的肝段／叶为基本的方案是治疗肝胆管结石的有效手段。（3）重视肝胆管结石合并症的诊治及并发症的防治可提高疗效。

Surgical diagnosis and treatment of hepatolithiasis

Objective To summarize the clinical experience in diagnosis and treatment of hepatolithiasis. Methods The clinical data of 320 patients with hepatolithiasis treated in our hospital in the past 15 years were retrospectively analyzed. Results For the 320 patients, all were examined with B-mode ultrasonography (100%) and 30 re-examined with MRCP (9.4%) preoperatively. Of all the 320 cases, 162 (50.6%) were accompanied with bile stricture and 3 (0.9%) with cholangiocarcinoma. The types of hepatectomy included left lateral hepatectomy or left hemihepatectomy in 253 cases (79.1%), right multiple segmental resection in 39 (12.1%), quadrate lobectomy in 20 (6.2%) and right hemihepatectomy in 8 (2.5%). After the operation, complications occurred in 20.4% of the patients and the rate of residual stone was 19.8%. The postoperative follow-up for 0.5-5 years showed that the rate of excellent and good outcome was 87.5%. Conclusions 1) MRCP is better than other methods in preoperative localization-diagnosis of hepatolithiasis. 2) The "individualized program" of multiple segmental resection including focus is an effective means for treating hepatolithiasis. 3) Paying more attention to diagnosis and treatment of accompanying diseases and prevention and treatment of complications can promote the therapeutic efficacy.