肝胆管结石的外科治疗(附1643例分析)

目的 探讨肝胆管结石临床变化规律和治疗措施。方法 对我院收治的肝胆管结石1643例按住院时间分前、后10年两组分析。结果 后10年较前10年病人住院率减少45％，手术率增加10.62%，急诊手术率、并发症发生率、病死率分别下降15.51%、6.88%、1.8%。结论 肝胆管结石的发病率降低、病人就诊及时、手术接受程度提高，使急诊入院、急诊手术、合并严重并发症病人比例下降，对改善治疗效果起了重要作用。对“去除病灶、防止复发”理解深化，较为积极的采取肝切除术、常规运用术中胆道镜治疗HS，术后消炎利胆巩固治疗，可显著降低结石残留率和胆管炎复发率。

Surgical treatment of hepatolithiasis-a analysis of 1643 cases

Objective To investigate the clinical features of hepatolithiasis and its curative methods.Methods Of 1643 patients with hepatolithiasis treated in our hospital from January 1982 to December 2001,1060 cases admistted in the former ten years were divided into group A and 583 cases admistted in the later ten years into group B,and their clinical data were retrospectively analyzed.Results The admission rate in group B reduced 45% but surgical operation rate increased 10.62% compared with that in group A.The emergency operation rate,complication occurring rate and mortality also descended 15.51%,6.88% and 1.8% respectively in group B.Conclusion The emergency admission rate and emergency surgical operation rate increased and serious complication rate decreased because the patients sought medical advice promptly and were more willing to accept surgical operation deep understanding the necessity of removing focus and preventing recurences by liver excises,use of choledochoscope and diminishing inflammation may play an important role to improve the curative effect on hepatolithiasis and notably decrease the stone residual rate and cholangitis recurrence rate.