规则性肝段切除联合胆道镜取石治疗肝内胆管结石131例临床剖析.docVIP

规则性肝段切除联合胆道镜取石治疗肝内胆管结石131例临床剖析 　　【摘要】 目的:探讨规则性肝段（叶）切除联合胆道镜取石治疗肝内胆管结石的方法及远期疗效。方法:回顾性总结1998年1月至2009年12月我院规则性肝段（叶）切除、胆总管探查、T管引流术(术中联合胆道镜取石)治疗肝内胆管结石术后恢复情况，结石残留、复发，胆道感染等情况。结果 131例患者术后恢复良好，康复出院，无手术死亡。随访112例10个月至8年，93例（83.0％）症状消失，8例（7.1％）术后结石残留，7例（6.3％）术后复发，5例（4.5％）胆道反复感染疼痛。结论 规则性肝段（叶）切除联合胆道镜取石术是安全的，可降低残石率，结石复发率，是目前治疗肝内胆管结石最有效方法之一。? 　　【关键词】 肝内胆管结石；肝段切除术；胆道镜? 　　【中国分类号】 R62【文献标识码】 B【文章编号】 1044-5511（2012）02-0025-02?? 　　【Abstract】 Objective To investigate the methods and long-term follow-up results of treating hepatolithiasis with regular liver lobes resection combined with choledochoscopic stone-removing. Methods To summarize the recovery, the residual stone, the recurrence and infection of biliary tract of regular liver lobes resection, exploration of the common bile duct and choledochotomy and T-tube drainage combined with choledochoscopic stone-removing in Guangan People Hospital from January, 1998 to December, 2009. Results 131 cases recovered to good health and discharged from our hospital upon recovery and there were no operative deaths. In the follow-up of 112 cases for 10 months to 8 years, 112 cases (83.0%) had the transference cure, 8 cases (7.1%) had the residual stones, 7 cases (6.3%) had the recurrence, and 5 cases (4.5%) had the infection and ache of biliary tract repeatedly. Conclusion It is safe for regular liver lobes resection combined with choledochoscopic stone-removing to reduce the stone residue rate and the stone recurrence rate. It is one of the most effective ways which cure hepatolithiasis.? 　　【Key words】 hepatolithiasis; segmental hepatectomy; T-tube cholangiography?? 　　 肝内胆管结石往往沿病变胆管呈区域性或节段性分布，规则性肝段切除术能最大限度地清除含有结石、胆管狭窄及扩张的病灶，又同时切除了病变肝脏，是治疗肝内胆管结石最有效的手段［1、2、10］，联合胆道镜治疗可降低术后结石残留率及术后结石复发率［3］。我院1998年1月至2009年12月间对肝内胆管结石呈局限型分布的患者采用规则性肝段（叶）切除，术中联合胆道镜取石治疗131例，取得较好的远期效果，现报告如下：? 　　1 临床资料? 　　1．1 一般资料:本组患者男52例，女79例，年龄22～68岁，中位年龄46岁。结石分布于左外叶43例、左半肝46例、右后叶16例、右半肝8例、双侧肝叶18例。合并肝段、肝叶萎缩89例，肝脓肿3例。有1～3次手术史37例。术前均行B超、CT检查，58例行MRCP检查，27例行ERCP检查（详见表1）。? 　　1．2 手术