肝内胆管结石的外科诊断与治疗

目的 总结肝胆管结石诊治的临床经验。方法 回顾性分析78例肝胆管结石的定位诊断、术式选择和治疗结果。结果 术前检查与术中所见符合率B超为80．8％，CT为87．5％，B超联合CT为93．8％；局限于左肝管或右肝管结石行相应肝段／叶切除治愈率96．4％；双侧肝胆管结石行-侧肝段／叶切除 高位肝胆管切开取石 术后胆道镜取石治愈率达72．7％。结论 ①B超联合CT在肝胆管结石的术前定位诊断中优于单-B超或CT检查。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肝段／叶切除 术后胆道镜取石能提高双侧肝胆管结石的治愈率。

THE SURGICAL DIAGNOSIS AND TREATMENT OF HEPATOLITHIASIS

Objective To summarize the clinical experience in diagnosis and treatment of hepatolithiasis.Methods The clinical data of 78 patients with hepatolithiasis treated in our hospital in the past 11 years were retrospectively analyzed.Result The diagnostic accuracy of the preoperative examination by B mode ultrasound is 63/78(80.8%),the one by CT is 28/32(87.5%),and the one by B mode ultrasound combined with CT is 30/32(93.8%).The percent of cure is 96.4% by lobe/segment hepatectomy in case which stone merely located in left or right hepatobiliary duct,and the percent of cure is 72.7% in which stone located in dual hepatobiliary duct by one side lobe/segment hepatectomy combined with high location hepaticolithotomy and postoperative choloedochoscopy examination.Conclusion (1)The B mode ultrasound combined with CT in preoperative locational diagnosis of hepatolithiasis is better than only by B mode ultrasound or only CT.(2)The synthesis therapy base on the lobe/segment hepatectomy including focus is an effective means for treating hepatolithiasis;(3)Lobe/segment hepatectomy combine postoperative choledochoscopy examination can enhance the curability of dual hepatobiliary duct stone.