摘要
目的探讨肝内胆管结石不同手术方式的治疗效果。方法收集我科2006年至2009年肝内胆管结石患者的病例资料,根据手术方式的不同,分为肝切组(71例)和非肝切组(96例)。结果 167例患者均顺利完成手术,术后出现并发症36例,肝内胆管残余结石82例,其中肝切组31例(43.7%),非肝切组51例(53.1%),经胆道镜取石,平均2.63次,结石取净率92.5%。132例患者获得随访,随访时间6～42个月。肝切组疗效优良者49例(92.5%),非肝切组疗效优良者66例(83.5%),两组间差异有统计学意义(P=0.037)。术后6个月以上结石复发者14例(肝切组5例,非肝切组9例),非肝切组继发胆管癌者4例。结论规则性肝切除仍是目前治疗肝内胆管结石最为理想的术式。术中与术后娴熟的胆道镜技术可取尽大多数肝内胆管结石,近中期随访大多数患者获得理想临床疗效。
Objective To analyze the outcome of different operative procedures for the intrahepatic lithiasis.Methods From 2006 to 2009, the clinical data of 167 consecutive patients suffered from intrahepatic lithiasis were reviewed and followed. Ninty-six patients were treated with choledochotomy and T-tube drainage, the others plus with partial hepatectomy. Results All one hundred and sixty-seven patients were undergone by different curative modes. Thirty-six patients had the early complications; Residual stones were found in the intrahepatic bile duct in 82 patients after operation, thirty-one patients in the partial hepatectomy group （43.7%） and 51 patients in the group without partial hepatectomy （53.1%）. All of them were treated by cholangioscopy. The mean times of cholangioscopy were 2.63. The stone clearance rates was 92.5%. Follow-up data were available in 132 patients with 6 - 42 months （median follow-up of 21 months）. The rate of follow-up was 79.0%. The curative effect of 49 patients by the follow-up was well in the partial hepatectomy group （92.5%）, and 66 patients in the latter group （93.5%）. The difference was ststistically significant. The recurrent stones in the intrahepatic bile duct were found in 14 cases. 4 patients were final diagnosised by hepatocholangiocarcinoma in the group without partial hepatectomy. Conclusion Regular hepatectomy is the best method for the primary intrahepatic lithiasis at present. Through cholangioscopy intra-operatively and post-operatively to remove most of the stones and the short-term follow-up is satisfied.
出处
《肝胆胰外科杂志》
CAS
2013年第2期100-102,共3页
Journal of Hepatopancreatobiliary Surgery
关键词
肝内胆管结石
胆道镜
规则性肝切除
intrahepatic lithiasis
cholangioscopy
regular hepatectomy
