肝内胆管结石92例手术治疗分析  

Surgical treatment of hepaticolithiasis:a report of 92 cases

作　　者：章庆华[1] 刘广成[1] 沈建生[1] 袁正[1] 黄勇波[1] 

机构地区：[1]广东医学院第三附属医院外三科,广东茂名525000

出　　处：《中国普通外科杂志》2005年第1期4-6,共3页China Journal of General Surgery

摘　　要：目的　探讨肝内胆管结石手术治疗方法和时机对疗效的影响。方法　回顾性分析手术治疗 92例肝内胆管结石的临床资料。结果　 (1)术后并发症发生率 14 .1% (13 /92 ) ,其中术中使用胆道镜者 9.3 % (4 /4 3 ) ,未使用胆道镜 18.4% (9/4 9) ,急诊手术组 3 6.0 % (9/2 5 ) ,择期手术组 6.0 %(4 /67)。 (2 )术后胆道残余结石率 2 2 .9% (2 1/92 ) ,使用胆道镜者 13 .9% (6/4 3 ) ,未使用胆道镜组3 0 .6% (15 /4 9) ;急诊手术组 9/2 5例 (3 6.0 % ) ,择期手术组 17.9% (12 /67例 )。 (3 ) 1例于术后 2d死于ACST。全部病例随访 4～ 10年 ,疗效优良为 87% (80 /91)。结论　合理的手术方式 ,配合胆道镜 ,适时的手术时机 ,可明显提高肝内胆管结石的疗效 ,减少并发症的发生。Objective To assess the therapeutic effect and opportune time of surgical treatment of hepaticolithiasis . Methods The clinical data of 92 patients with hepaticolithiasis who underwent surgical treatment were analyzed retrospectively. Results (1) The incidence of postoperative complications was 14.1% (13/92 cases), in choledochoscopy group it was 9.3%(4/43 cases) and in the non choledochoscopy group 18.4%(9/49 cases) ; in the emergency operation group it was 36%(9/25 cases) and in selective operation group 5.97%(4/67 cases) . (2) The incidence of residual stones was 22.9%(21/92 cases); in choledochoscopy group it was 13.9%(6/43 cases) and the non choledochoscopy group 30.6%(15/49 cases); in emergency surgery group it was 36%(9/25 cases) and in selective operation group 17.9%(12/67 cases).(3)One pationt died from ACST two days after operation . All of the patients were followed up for 4-10 years; there were 80 cases (86.9%) who had a good therapeutic outcome. Conclusions Logical surgical procedure associated with choledochoscopy and appropriate timing of surgical intervention can markedly improve the effect of surgical treatment of hepaticolithiasis and reduce the incidence of postoperative complications.

关 键 词：胆结石/外科学 胆管 肝内/外科学 

分 类 号：R657.42[医药卫生—外科学] R322.47[医药卫生—临床医学]