复杂性肝内胆管结石的外科治疗

目的　总结复杂性肝内胆管结石的外科治疗方法及效果。 方法　 总结分析１９９２ ～１９９８ 年外科治疗复杂性肝内多段胆管结石并多处胆管狭窄３５ 例的手术方法，总结显露与切开肝内狭窄段胆管、取出结石、解除狭窄的经验和体会。 结果　３５ 例无手术死亡，术后近期并发感染、胆漏、肝功能不全或消化道出血共７ 例，均治愈；残留结石９ 例，术后经胆道镜取净结石７ 例。随访６ 个月至５ 年６ 个月２４ 例，优良２１ 例（８８ ％ ） ，好转２ 例（８ ％ ） ，无效１ 例（４ ％ ） 。 结论　复杂肝内胆管结石外科治疗的关键是显露和切开肝内各叶段胆管的狭窄段，取出结石、建立通畅的胆流通道。经肝门区或肝方叶可以显露和切开肝门胆管、左右肝管和左内叶、右前叶胆管，经肝膈面切开肝实质进路，可以显露和切开右肝内各叶段胆管。

Surgical treatment of complex intrahepatic biliary calculi

Objective To evaluate the method and result of surgical treatment for complex intrahepatic biliary calculi. Methods Between 1992 and 1998, 35 patients were admitted for complex intrahepatic biliary calculi.Patients undergone biliary lithotomy by multiple incision made on the bile duct strictures disseminating on different hepatic lobes and segments, hence the exposure of the strictured duct and the bile ductplasty after the cholangiotomy was the major challenge. Results There was no mortality,inhospital complications developed in 7 cases including postoperative infection, biliary fistula, hepatic insufficiency and hemorrahge of gastrointestinal tract, all were cured. Residual stones were removed through cholangioscopy in 7 of 9 cases, 24 patients were followed up from 6 months to five and half years, and the result was excellent in 21 (87 5%), good in 2 (8 3%), ineffective in 1 (4 2%). Conclusions The key of the surgical treatment of the intrahepatic calculus include incision and exposure of the stricture of the intrahepatic bile duct, removing the stone and reconstructing bile drainage. Bile ducts of hilus hepatis, right or left lobe, medial segment and anterior right segment can be exposed and incised through hilus hepatis or quadrate lobe.All major intrahepatic bile ducts of the right lobe can be exposed and incised by an approach cutting through the liver parenchyma on its diaphragmatic surface.