肝内外胆管结石患者术后病变胆管的影像学转归

目的：通过观察肝内外胆管结石患者治疗前后受累胆管的影像学变化评估治疗效果。方法：收集2006—2009年间符合条件的62例肝内外胆管结石患者的临床资料并进行随访，复查MRI+磁共振胰胆管造影（MRCP）。根据手术方式分成A组（胆总管切开取石+T管引流+肝部分切除术，8例），B组（胆总管切开取石+T管引流+肝部分切除术+术后经T管窦道胆道镜取石术，16例），C组（胆总管切开取石+T管引流+术后经T管窦道胆道镜取石术，38例）。观察各组的影像学转归情况；将各特征因素进行分级赋值，累计每组手术前后的评分分值，判断疗效。结果：全组手术前后肝内胆管扩张率、肝外胆管扩张率、肝内胆管狭窄率分别为98.4% vs. 79.0%，90.3% vs. 67.7%，40.3% vs. 29.0%；术后结石复发率为9.7%。3组术后的胆总管最大径均较术前明显减小（均P<0.05），A组手术前后肝内胆管最大径差异无统计学意义（P>0.05），而B，C组均明显小于术前（均P<0.05）。3组术后评分均明显低于术前（均P<0.05），而3组间两两比较结果显示，B组手术前后评分差值大于C组，差异有统计学意义（P<0.05）。结论：经手术及胆道镜取石后，受累肝内外胆管大多未能恢复至正常状态。肝部分切除是对肝内胆管结石治疗的理想术式。

Evolution of postoperative imaging of the affected bile ducts in patients with intra- and extrahepatic stones

Objective: To determine therapeutic efficacy in patients with intra- and extrahepatic stones by observation of the imaging evolution of the affected bile ducts before and after operation. Methods: The clinical records of 62 patients with intra- and extrahepatic calculi who met the criteria between 2006 to 2009 were selected, and then the patients were followed up and reexamined with MRI and magnetic resonance cholangiopancreatography (MRCP). The patients were divided, according to the types of surgery performed, into group A (8 cases, undergoing choledocholithotomy, T-tube drainage and partial liver resection), group B (16 cases, undergoing choledocholithotomy, T-tube drainage, partial liver resection, and choledochoscopic lithotomy via T-tube sinus tract) and group C (38 cases, undergoing choledocholithotomy, T-tube drainage, and choledochoscopic lithotomy via T-tube sinus tract). The imaging evolutions of each group were observed. The disease characteristic factors were assigned weighted values, according to which the scores of each group before and after operation were calculated to assess the therapeutic effects. Results: In the entire group, the pre- and postoperative rate of intrahepatic bile duct dilatation, extrahepatic bile duct dilatation and intrahepatic bile duct stricture was 98.4% vs. 79.0%, 90.3% vs. 67.7%, and 40.3% vs. 29.0% respectively, and recurrence rate was 9.7%. By comparison of the results before and after operation, the maximal diameters of the common bile duct in the three groups were all significantly reduced (all P<0.05), and the maximal diameters of the intrahepatic bile duct in group B and group C were markedly decreased (both P<0.05), and except in group A, it did not reach statistical significance (P>0.05). The postoperative scores in the three groups were all significantly decreased (all P<0.05), and the results of the pairwised comparison showed that the difference-value between pre- and postoperative scores in group B was significantly higher than that in group C (P<0.05). Conclusion: Most of the affected intra- and extrahepatic bile ducts do not recover into their normal state after operation and choledochoscopic lithotomy. Partial hepatectomy is an ideal procedure for intra- and extrahepatic stones.