肝胆管结石合并肝门部胆管狭窄的诊断和治疗

目的 总结肝胆管结石合并肝门部胆管狭窄诊治的临床经验。方法 回顾性分析l12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l12例(准确率73．8％)，CT 74例(准确率86．5％)，PTC 31例(准确率93．5％)，ERCP 41例(准确率92．6％)，MRCP 28例(准确率96．4％)。全组均采取肝方叶切除，肝胆管切开取石、整形，高位胆肠吻合术进行治疗。术后并发症发生率10．75％，残石率18．7％，结石复发率为5．4％，优良率90．1％。结论 (1)，MRCP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)肝方叶切除是治疗肝胆管结石合并肝门部胆管狭窄的有效手段。(3)重视肝门部狭窄胆管的处理是提高疗效的关键。

The diagnosis and treatment of hepatolithiasis accompanied with bile stricture near porta hepatis

Objective To summarize the clinical experiences on diagnosis and treatment of hepatolithiasis accompanied with bile stricture near porta hepatis. Methods Altogether 112 cases of hepatolithiasis with surgical treatment were reviewed during the past 15 years. Result In the 112 cases, all were examined with B-ultrasound(accuracy: 73.8%) preoperative, 74 cases with CT (accuracy: 86.5%),31 cases with PTC(accuracy: 93.5%),41 cases with ERCP (accuracy: 92.6%),28 cases with MRCP(accuracy: 96.4%). All the cases were treated under the quadrate lobectomy, cutting open and taking rocks from bile duct, hepatobiliary stricture plasty, and hepatocholangiojejunostomy in the hpatic hilum. Complications occurred in 10.75% patients and the rate of residual stone was 18.7% and the rate of recurrent was 5.4% postoperative. The Excellent and good result rate was 90.1%. Conclusion (1) MRCP is the best technique in the diagnosis of hepatolithiasis accompanied with bile stricture near porta hepatis. (2) The quadrate lobectomy is an effective mean of treating patients with hepatolithiasis accompanied with bile stricture near porta hepatis. (3) It is the linchpin that attach importance to how to deal with the bile stricture, which can rise the effect.