肝内胆管结石伴狭窄86例外科治疗体会

目的总结肝内胆管结石伴狭窄的外科治疗经验。方法回顾总结86例肝内胆管结石并狭窄患者的外科治疗,其中狭窄胆管切开成形和胆管-空肠(Roux-en-y)吻合术42例(占48.7%);肝部分切除术44例(占51.3%)。结果术后B超及胆管造影检查:左肝内胆管结石49例,治愈47例;右肝内胆管结石11例,治愈8例;双侧肝内胆管结石12例手术后治愈;余14例残余肝内胆管结石经1~4次术后胆道镜取石;9例取净肝内残余结石而治愈。随访1~8年者75例,无再手术率。结论肝部分切除术是治疗肝内胆管结石的最理想术式,一些非肝切除术有时亦是可取的,术后纤维胆道镜检查与治疗对诊治残余结石有重要意义。

Experience of surgical treatment for 86 cases of calculus of intrahepatic duct complicated with stenosis

Objective To summarize the experience of surgical treatment for calculus of intrahepatic duct complicated with stenosis.Methods The clinical data of 86 cases performed with surgical treatment for calculus of intrahepatic duct complicated with stenosis were retrospectively analyzed.Among of them 42 cases(48.7%) performed with incision of strictured duct and Roux-en-Y choledochojejunostomy,42 cases (51.3%) performed with partial hepatectomy.Results Examination of postoperative B ultrasonography and cholangiography demonstrated that 49 patients with calculus of left intrahepatic duct, 47 patients were cured;eleven patients calculus of right intrahepatic ductright intrahepatic duct,8 patients were cured;twelve patients with calculus of bilateral intrahepatic duct were cured;the rest 14 patients with residual calculi underwent extraction of calculi by choledochoscopy for one to four times,nine patients were cured with complete extraction of calculi.Seventy-five cases were performed with follow-up of one to eight years.No reopoeration occurred.Conclusion Partial hepatectomy for calculus of intrahepatic duct is an optimal surgical procedure.Non-hepatectomy is sometimes appropriate treatment for some patients. Postoperative examination and treatment by choledochoscopy play an important role in diagnosing and treating residual calculi.