肝胆管结石合并胆汁性肝硬化83例治疗回顾性分析

目的探讨肝胆管结石合并胆汁性肝硬化治疗方法和效果。方法回顾性分析83例肝内胆管结石合并胆汁性肝硬化病例的治疗情况。结果本组病例结石广泛分布于肝内及肝外胆道。12%(10/83)合并胆管癌。残余结石率为28.9%。肝叶切除42例,肝叶切除 胆肠吻合8例,胆肠吻合8例,胆管切开取石引流25例,脾切除 门奇断流13例。肝叶切除组优良率(90%),肝叶切除 胆肠吻合组优良率(87.5%),胆管切开取石引流组78%,胆肠吻合组75%,肝叶切除、肝叶切除 胆肠吻合组优良率高于单纯切开、胆肠吻合组;但各组在并发症率及残余结石率统计学上差别无显著性。脾切除 门奇断流组在并发症和优良率上与未行脾切除 门奇断流组统计学上差别无显著性。结论(1)肝叶切除去除病灶,纠正胆管狭窄是处理肝胆管结石,缓解肝硬化的有效方法。(2)门脉高压症脾亢患者,肝功能较好者可在肝叶切除、胆肠吻合同期做脾切除加贲门周围血管离断术。

RESTROSPECTIVE ANALYSIS OF INTRAHEPATIC CHOLELITHIASIS ASSOCIATED WITH BILIARY CIRRHOSIS (WITH 83 CASES REPORTED)

Objective To explore the therapeutic method and efficacy of intrahepatic cholelithiasis associated with biliary cirrhosis.Methods 83 cases with intrahepatic cholelithiasis associated with biliary cirrhosis from 1990 to 2002 were analyzed retrospectively.Result 42 cases underwent hepatectomy,8 cases did hepatectomy combined with bilioenteric anastomosis,8 cases did bilioenteric anastomosis,25 cases did simple choledochotomy,13 cases did splenectomy combined with portazygous devascularization.39.8% were associated with biliary stricture.12% associated with cholangiocarcinoma.Retained calculi rate was 28.9%.The excellent rate of hepatectomy was 90%,the excellent rate of hepatectomy combined with bilioenteric anastomosis was 87.5%,both were better than other groups.Conclusion Hepatectomy and relief stricture of bile ducts are efficacious way to avoid the progress of liver cirrhosis.Portal hypertension associated with hypersplenism,hepatectomy and/or bilioenteric anastomosis,splenectomy combined with portozygos devascularization can be performed at the same time in those who have good liver function.