摘要
目的探讨纤维胆道镜在复杂性肝内胆管结石治疗中的临床应用价值。方法回顾性分析应用胆道镜治疗37倒复杂性肝内胆管结石患。者的情况及术后2年内的随访资料。结果37例患者均有一、二级的胆管狭窄，其中17例（17／37）伴有三级胆管开口处狭窄；术后1年随访。21例Ⅲa型以下的患者结石全部排净，结石取净率58％（21／37）：三级胆管内有残留结石16例，其中11例（11／16）有三级胆管开口处狭窄，然而有三级胆管狭窄的17例患者只有5例（5／17）结石全部排净，且Ⅲb及Ⅳ型的12例患者均有三级胆管不同程度的结石残留，结石残留与“三级胆管开口狭窄或肝纤维化改变”具有相关性[25％（5／20）vs64．7％（11／17），P〈0．01]；术后2年随访，既往有残留结石而无三级胆管开口狭窄的5例结石经保守治疗全部排净；仅1例因反复胆管炎、胆管狭窄、结石复发而再次手术治疗。结论彻底解除一、二级等大胆管的狭窄、保持胆汁引流的通畅是治疗复杂性肝内结石的关键；“三级胆管开口狭窄或肝纤维化改变”与结石残留、排石治疗无效等可能具有相关性；胆道镜探查对复杂性肝内结石治疗方法的选择具有重要的指导性意义。
Objective To evaluate the clinical significanees of Choledochofibcrscopy in treating complex hcpatolithiasis. Methods Collective data oil the therapeutic procedures and the subsequently postoperative outcomes in 2 years were retrespectively analyzed in 37 cases undergoing surgical-operation combined Choledoehofiberscoplc treatment for complex hcpatolithiasis. Results The precise information of intrahepatic biliary duct strictures （IBDS） ,adjuvant rectified strictures were obtained and complete clearance of stones in larger duct were achieved if only proficient application of Choledochofiberscopy. Intrahepatic biliary duct strictures（IBDS） lied in the first or second order branches of duct in all 37 cases,17 of them had subsequent strictures in the entry of third branches （SETB ）. 1 year after, the rate of incomplete clearance of stones was 58 % （21/37 ） entirely attributed to less of Ⅲ a pathologic classification. Residual stones wcre reexamined in other 16 cases, furthermore 11 patients were explored with SETB. However,5 of 17 cases with SETB had clearance of intrahepatic stones. 12 cases with Ⅲ b or Ⅳ pathologic classification were found with residual stones. The rate of residual stones was significantly related to ＂stricture in SETD or pathologic hepatofibrosis＂ [ 25 % （5/20） vs 64.7% （11/17）, P 〈 0.01 ]. Then the postoperative outcomes after consecutive 2 years showed that all stones in 5 cases owing residual stones but nostricture in SE＇TD were cleaned out after regularly conservative therapy. Only I case accepted the second operation because of recurrent hepatolithiasis, IBDS and cholangitis. Conclusion It is critical to rectify strictures thoroughly and remold biliary drainage duct. There might be correlated between ＂stricture in SETD or pathologic hepatofibrosis＂ and residual stones, invalid medication. Adjuvant choledochofiberscopic exploration might play an important role in treating complex hepatolithiasis.
出处
《中国综合临床》
北大核心
2007年第1期61-63,共3页
Clinical Medicine of China
关键词
肝胆管结石
纤维胆道镜
Hepatolithiasis
Cholcdochofiberscopy
