摘要
目的 :探讨纤维胆道镜在肝内胆管结石系统性治疗中的作用。方法 :对 1981.11～ 2 0 0 0 .12收治的并经各种治疗的肝内胆管结石 786例 ,提出系统性治疗及纤维胆道镜外科技术应用的方法。①治疗前通过各项影像学检查 ,了解肝内胆管结石的数量、分布 ,有无肝胆管狭窄存在及程度 ,有无肝萎缩及范围 ;②术前系统性治疗 :驱蛔、消炎利胆、经T管胆道冲洗 ;③手术与术中系统性治疗 :以手术为主体 ,同时采用术中胆道镜、术中胆道造影 ;④术后系统性治疗 :术后胆道镜、经胆道外引流管射流震荡冲洗、持续灌注冲洗、溶液溶石治疗等。结果 :术中胆道镜应用后使手术残石率由 79% (314/ 398)降低为 2 4% (96 / 398) ,经术后胆道镜等系统性治疗后 ,最终残石率降至 2 % (19/786 )。结论 :①只有采取系统性治疗措施 ,才能根本改善肝内胆管结石的疗效 ;②胆道镜外科技术在系统性治疗中发挥着至关重要的作用 ;③术中胆道镜的应用有利于正确选择手术方式 ,既可有效地降低术后残石率 ,又能减少手术创伤 ;④术后胆道镜治疗 ,直接关系到肝内胆管结石最终残石率 。
Objective: To explore the role and methodology of choledochoscopy in the comprehensive treatment of hepatolithiasis. Methods: From Nov. 1981 through Dec. 2000, comprehensive therapy associated with per-operative and post-operative choledochoscopy was applied to 786 cases of hepatolithiasis: ① Before the treatment: imaging tests were made to define the quantity and distribution of hepatolithiasis, the existence and severity of ductal stricture(s), and the extent of hepatic atrophy. ② Pre-operative treatment: treatment of ascaridosis, relieving inflammation and irrigation of the ductal system through T-tube. ③ Operative and per-operative treatment: making the operation as the key point and taking full advantage of per-operative choledochoscopy and cholangiography. ④ Post-operative therapy: repeated irrigation of the ductal system via external drainage tube of the bile duct and treatment with stone-dissolving solution(s). Results: The application of per-operative choledochoscopy decreased the residual stone rate from 79%(314/398) to 24%(96/398), and to 2%(19/786) after the application of post-operative treatment. Conclusions: ① Only by taking advantage of the recommended comprehensive therapy can the therapeutical effect of hepatolithiasis be fundamentally improved. ② Choledochoscopy and associated techniques play a important role in the therapy. ③ The application of per-operative choledochoscopy contributes to the proper choice of the operative procedure which reduces not only the residual stone rate, but also the rate of per-operative ductal injury. ④ The application of post-operative choledochoscopy is directly related to the final results of treatment. It should be used routinely after operation.
出处
《外科理论与实践》
2002年第3期193-195,共3页
Journal of Surgery Concepts & Practice
