外科治疗2465例原发性肝内胆管结石的临床总结

目的 总结原发性肝内胆管结石的外科治疗经验。方法 对近25年来收治的2465例原发性肝内胆管结石的临床资料进行回顾性分析。结果 手术方式：单纯外引流2034例（82.5％）,单纯内引流手术431例（17．5％）,附加肝部分切除586例（23．8％）。术后发生各种并发症211例（8．6％）,术后围手术期死亡17例（0.7％）。术后获得随访共1767例（71．7％）,随访时间2—25年,疗效优良1518例（85.9％）。术后发现残余结石315例（17．8％）。115例（6．5％）结石复发。结论 术前影像学全面地了解结石的分布和胆管狭窄的部位,术中应用各种取石方法,恰当的肝部分切除,合理的引流方式,术后应用胆道镜取石,能有效地减少术后并发症的发生,降低残石率和结石复发率。

Surgical treatment of 2465 primary hepatolithiasis cases

Objective To summarize the experience of surgical treatment of primary hepatolithiasis. Methods To analyze the clinical data, operation choice, postoperative complications of 2465 cases of primary hepatolithiasis retrospectively. Results Of the patients, 2034 received external drainage(82.5%) and 431 received internal drainage(17.5%) and 586 were performed adjunctive partial hepatectomy (23.8%). The postoperative complications were found in 211 cases(8.6%) and 17 cases(0.7%) died after the operation. One thousand seven hundred and sixty-seven cases(71.7%) have been followed up for 2 to 25 years, among them therapeutic effect of 1518 cases(85.9%) was excellent or good, 315 cases(17.8%) had residual stone and 115 cases(6.5%) recurred. Conclusions It could decrease the incidence rate of complications, residual stone and recurrence in the patients with hepatolithiasis after surgical therapy to pinpoint the situs of the lithiasis and biliary stricture and managed properly before the surgery.