肝胆管结石病130例临床分析.DOCVIP

临床医学论文-肝胆管结石病130例临床分析 ???????????? 作者：朱小建，李运奇，王继武，李景煜 【摘要】? 目的 总结肝胆管结石病的外科治疗经验。 方法 回顾性分析从1996年1月～2005年12月130例肝胆管结石病外科治疗的术式选择和治疗效果。其中肝胆管切开取石T管引流术47例，肝胆管切开取石+胆肠吻合术39例，肝部分切除术28例，肝门部胆管切开成形+胆肠吻合术16例。结果 114例得到随访，随访6个月～10年，术后优良率及残石率分别为：肝胆管切开取石T管引流术67.57%、54.05%，肝胆管切开取石+胆肠吻合术78.38%、32.43%，肝部分切除术96.15%、7.69%，肝门部胆管成形+胆肠吻合术85.71%、14.29%，总优良率79.82%、残石率31.58%。结论 充分利用现代诊疗手段，对病情做出正确判断，选择合理的手术方式，是提高肝胆管结石病治疗效果的关键。 【关键词】? 肝胆管结石病；治疗 ??? 【Abstract】? Objective? To summarize surgical treatment experience on hepatolithiasis. Methods?The clinical data of 130 patients with?hepatolithiasis admitted in our hospital from Jan 1996 to Dec 2005 were analyzed retrospectively. 47 cases were undergone choledocholithotomy with T-tube drainage , 39 cases cholangiojejunostomy with T-tube drainage , 28 cases?lobectomy of liver, 16 cases plastic repair of hepatic portle duct with cholangiojejunostomy. Results?114 cases were follow-up surveyed from 6 months to 10 years, After operation,the superior rate and residual stone rate were?respectively: it was 67.57%、54.05% in the group of choledocholithotomy with T-tube drainage ,78.38%、32.43% in cholangiojejunostomy with T-tube drainage , 96.15%、7.69% in lobectomy of liver, 85.71%、14.29% in plastic repair of hepatic portle duct with cholangiojejunostomy. The total superior rate was 79.82% and total residual stone rate was 31.58%.Conclusion?It was the key to elevate therapeutic efficacy on?hepatolithiasis to utilize modern diagnosis and treatment means and exactly judge pathogenetic condition and choose reasonable?operation mode.. ??? 【Key words】? hepatocholangiolithiasis;treatment ??? 肝胆管结石病，又称原发性肝内胆管结石。在我国，它在结石性胆道病中占有较高的发病率。由于所处解剖位置特殊、病理变化复杂、对肝脏乃至对全身损害大，给临床上带来了两个有别于腹内其他外科病的突出问题：（1）接受手术治疗的患者约40%在入院时就存在化脓性胆管炎、肝脓肿等严重并发症，是非肿瘤性胆道疾病死亡的关键性因素；（2）很多患者出现术后残留结石与结石复发而需再次手术治疗。如何有效的降低肝胆管结石病的高并发症、高复发率及外科治疗中的再手术率是目前外科工作的基本出发点和着眼点，已引起国内学者的广泛注意与研究。本文总结1996年1月～2005年12月间130例手术治疗的肝胆管结石病，就有关治疗体会分析如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 本组患者130例，男58例，女72例；年龄35～68岁，中位年龄45岁。左肝胆管结石63例