肝内胆管结石的多模式治疗策略  

Multimodal Approach to Hepatolithiasis

作　　者：徐三荣[1] 程国祚[1] 张建新[1] 黄润生[1] 

机构地区：[1]江苏大学附属医院普外科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2004年第4期318-319,322,共3页Journal of Jiangsu University：Medicine Edition

摘　　要：目的 :总结多种术式治疗肝内胆管结石的临床经验。方法 :回顾性分析 1997年 6月至 2 0 0 3年 6月收治的肝内胆管结石病患者 6 8例 ;其中 ,肝部分切除术 +胆道镜应用治疗 5 7例 (83 82 % ) ;胆总管切开取石 +胆道镜应用治疗 11例 (16 18% ) ;肝胆管狭窄切开整形胆肠吻合术 +胆道镜应用治疗 7例 (10 2 9% ) ;肝部分切除联合胆肠内引流治疗 4例 (5 88% )。结果 :手术后结石取净 6 6例 (97 0 6 % ) ,术后胆道镜取石 2例 ,1例取净 ,总的结石取净率 98 5 3%(6 7/6 8) ;手术并发症 9例 (13 2 4 % ) ,无围手术期死亡 ;全部病人随访 6个月至 2年 ,肝内胆管结石复发 1例。结论 :以肝部分切除及胆道镜应用为主的多模式治疗策略是治疗肝内胆管结石的最佳方案。Objective: To sum up the clinical experience of the treatment of hepatolithiasis. Methods: A retrospective study was made in 68 patients with hepatolithiasis who had been treated with different kinds surgery operation from June 1997 to June 2003. Fifty seven patients (83.82%) were operated with hepatectomy combined with the application of fiber biliary endoscopy,11 cases(16.18%)with choledochotomy and taking stones combined with the application of fiber biliary endoscopy,7 cases(10.29%)with plastic of stenotic bile duct Roux-Y cholangiojejunostomy combined with the application of fiber biliary endoscopy,4 cases(5.88%)with hepatectomy combined with Roux-Y cholangiojejunostomy. Results: The stones of 66 cases(97.06%)were removed completely during the operation,while the residual stones of other 2 cases were removed by fiber biliary endoscopy with 1 of them succeeded. Nine patients were suffered from complication. All patients were followed up from 6 months to 2 years,and 1 case of recurrent hepatolithiasis was found. Conclusion: The multimodal approach relying mainly on hepatectomy and the application of fiber biliary endoscopy was a preferable treatment for hepatolithiasis.

关 键 词：肝内胆管结石 肝切除 胆道镜 

分 类 号：R657.42[医药卫生—外科学]