摘要
目的探讨肝内胆管结石外科治疗的方法及适应证选择。方法总结分析1964～1997年手术治疗肝内胆管结石1448例。根据结石的部位、分布、数量、大小和肝胆系统的病理变化状况分别选择不同术式或联合手术,配合使用纤维胆管镜取石、碎石等综合措施。结果平均3年以上的随访效果:局限性肝叶、段胆管结石,行肝切除,优良93.8%。多发肝胆管结石并狭窄,行肝胆管空肠吻合,优良88.7%。肝切除与肝胆管空肠吻合联合手术,优良91.1%。胆总管十二指肠吻合,优良70.8%。不伴胆管狭窄者,行胆道探查胆道镜取石,优良88.5%。单纯胆道探查器械取石,优良65.1%。结论利用现代影像技术、良好的胆系造影;明确并根据结石和肝、胆管系统的病理状况,分别选择不同术式或联合手术、配合胆道镜取石等综合措施,有利于提高疗效。
Objective To discuss the surgical procedure and choice of indication for treatment of intrahepatic biliary calculi(IBC).Methods A total of 1448 patients with IBC surgically treated in our hospital from 1964 to 1997 were reviewed.Operational procedures or combined operational procedures were chosen according to the location,classification,number and volume of the calculi and the patho- logical conditions of the intrahepatic bile duct.Meanwhile,other comprehensive treatments such as re- moving the stones by fiber cholangioscopy or hepatocolithotripsy were used.Results The follow-up for an average of 3 years showed that excellent outcome was achieved in 93.8% of the patients with lo- calized intrahepatic calculi receiving hepatectomy,88.7% of patients with multiple intrahepatic calculi complicated with stricture undergoing hepaticojejunalstomy,91.1% of patients undergoing hepatecto- my in combination with hepato—cholangiojejunstomy and 70.8% of those receiving cholangioduoden- ostomy,respectively.As for those patients without stricture of the bile duct,good results were a- chieved in 88.4% of those undergoing fibercholangioscopy to remove stones and 65.1% of those re- ceiving removing of stones by hands or apparatus,respectively.Conclusions The therapeutic efficacy can he promoted by using modern imaging techniques to give a good biliary tract contrast examination and choosing different operational procedures according to the pathological conditions of calculus and the biliary tract.Meanwhile,other multiple surgical treatments such as removing the calculus by fiber cholangioscopy can also be used.
出处
《中华肝胆外科杂志》
CAS
CSCD
2001年第10期583-586,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
胆结石
外科手术
Cholelithiasis
Surgical operation
