肝切除治疗肝内胆管结石的临床研究

目的 探讨肝切除治疗肝内胆管结石的效果及影响因素,研究既往胆道手术对肝内胆管结石治疗效果的影响及对策.方法 回顾性分析120例肝内胆管结石病例的临床资料,统计结石分布、术式选择、术后并发症和治疗效果.术中采用肝叶(段)切除、单纯胆总管探查取石T管引流、单纯胆肠吻合内引流、肝门成形胆肠吻合等术式,联合纤维胆道镜术中再诊断及辅助取石.术后结石残留,经T管窦道胆道镜取石.结果 近期结石总清除率86.7%,最终结石清除率100.0%.手术总并发症31例(25.8%).术后随访3个月～2.5年.总体治疗优良率86.7%.结论 肝叶(段)切除术安全、有效.既往多次胆道手术严重影响肝内胆管结石的治疗效果.首次针对肝内胆管结石手术的规范化有助于减少患者结石残留,提高结石清除率及治愈率. Abstract： Objective To study the treatment effects and affection of hepatolithiasis by resection of hepatic lobe and/or segments. And to investigate the affection of past biliary-tract surgery and how to avoid it. Methods The clinical data of 120 patients of hepatolithiasis were retrospectively analyzed.Stones distribution,operation modality,postoperative complications,and therapeutic effect were evaluated.During surgery we adopted hepatic lobe segment resection,common bile duct exploration simple T-tube drainage,simple drainage of biliary-enteric anastomosis,hepatic portal forming surgical biliary-enteric anastomosis,etc. Combined with choledochoscope rediagnosis and assisted in removing stones. Postoperative residual stones were removed via T-tube sinus tract by cholangioscopy. Results The total immediate stone clearance rate was 86.7%,and the final stone clearance rate was 100.0%. The total complication rate was 25.8%(31 cases out of 120 cases). Postoperative interview time was between three months to 2.5 years. The total effective curative rate was 86.7%. Conclusions Hepatic lobe(segment)resection is a safe and effective method in the treatment of intrahepatic bile duct stones. The past multiple biliary-tract surgery affected seriously the curative effect.The first standard surgery against the intrahepatic bile duct stones will help to improve the patient cure rate and lower reoperation rate and residual stones.

Clinical research of hepatectomy in the treatment of hepatolithiasis