肝内胆管结石的治疗探讨

目的 探讨肝内胆管结石的治疗方法及疗效。方法 对1991年1月至2001年12月的90例肝内胆管结石的各类治疗方法的疗效进行总结。结果 总管切开（包括肝内胆管剖开）取石＋“T”管引流20例（22％），肝叶切除，肝门部胆管原位整形胆管－空肠Roux-Y吻合21例（23％），左外叶切除＋“T”管引流25例（27％），左半肝切除11例（12％），右肝段楔形切除6例（6.6%）。肝门部胆管狭窄切开原们整形，包括3例脐静脉修补7例（7.7%）。随访结果表明：肝切除，胆管狭窄原位整形，肝管－空肠Roux-Y吻合是治疗肝内胆管结石的主要方法，能取得良好疗效。结论 肝叶或肝段切除是肝内胆管结石治疗的首选方法，胆肠吻合前必须先矫正胆管狭窄，清除结石病灶。

Study on the treatment of hepatolithiasis

Objective To study the therapeutic methods and effects of the treatment in hepatolithiasis.Methods 90 patients with hepatolithiasis were treated in our hospital from January 1991 to December 2001 and their clinical data were analysed respectively.Results 20 cases(22%)had cholangiotomy plus T-tube drainage.21 cases(23%)had hepatomy and their strictured bile ducts in the hilus were plasty with Roux-y cholangiojejunostomy.11 cases(12%)had segmental resection of the left liver plus T-tube drainage and 6 cases(6.6%) had segmental resection of the right liver.At follow-up,the results revealed that hepatectomy and plasty of stenotic bile duct Roux-Y cholangiojejunostomy were the main techniques adopted in the treatment of hepatolithiasis with good outcome.Conclusion Hepatectomy or segmental resection is ideal for treating hepatolithiasis.Plasty should be adopted to treat strictured bile ducts after the removal of stones and cholangiojejunastomy employed to reduce incidences of residual stones and recurrence.