2 肝切除治疗肝胆管结石并狭窄

目的探讨肝切除在肝胆管结石合并肝胆管狭窄治疗中的作用。方法回顾性分析82例肝胆管结石患者的定位诊断、术式选择、合并症、并发症及随访情况等临床资料。结果术前检查:B超诊断准确率为75.6%,CT准确率87.0%,PTC准确率90.9%,ERCP准确率93.5%,MRCP准确率94.4%。全组均采取结石所在部位肝叶、段切除,肝胆管切开取石、整形,高位胆肠吻合术等治疗。术后并发症发生率17.1%,残石率15.9%。73例随访1~16年,平均10.6年。随访期间结石复发率为6.8%,优良率90.4%。结论(1)MRCP等影像学检查是肝胆管结石合并肝门部胆管狭窄术前定位诊断的最佳方法。(2)肝叶、段切除是治疗肝胆管结石合并肝胆管狭窄的有效手段。(3)重视肝胆管狭窄的处理是提高疗效的关键。

Hepatectomy for treatment of hepatolithiasis accompanied with bile duct stricture

Objective To evaluate the role of hepatectomy in the treatment of hepatolithiasis accompanied with hepatobiliary stricture.Methods The clinical data of 82 cases of hepatolithiasis who had surgical treatment during the past 16 years were reviewed.Results Preoperatively,all were examined with B-ultrasound(accuracy: 75.6%),46 cases with CT(accuracy: 87.0%),22 cases with PTC(accuracy: 90.9%),31 cases with ERCP(accuracy: 93.5%),and 18 cases with MRCP(accuracy: 94.4 %).All the cases were treated by resection of the hepatic lobe or segment with stones,cholangiotomy and removal of stones,hepatobiliary strictureplasty,and hepatocholangiojejunostomy at the hepatic hilum.Complications occurred in 17.1% of patients,the rate of residual stones was 15.9%.Seventy-three cases were followed up for averag 10.6 years(1~16 years).In the follow-up period,the rate of recurrent stones was 6.8%.The excellent and good result rate was 90.4%.Conclusions (l) MRCP is the best technique for the diagnosis of hepatolithiasis accompanied with hepatobiliary stricture.(2) Hepatectomy is an effective means for treating patients with hepatolithiasis accompanied with hepatobiliary stricture.(3)The key to improve therapeatic results is to pay special attention in the treatment of bile duct stricture.