【摘要】 目的通过术式改进以提高肝内胆管结石的治疗效果。方法 4 8例肝内胆管结石患者接受了治疗 ,其中结石限于左肝 13例 (2 7% ) ,右肝 9例 (19% ) ,两肝均有结石 2 6例 (5 4 % ) ;结石并狭窄者 34/ 4 8(71% )。所有患者均打开肝门部胆管、纠正狭窄 ,使肝门胆管成一盆状 ,保留Oddi括约肌功能 ,取一段游离空肠修复胆管前壁 ,盲端埋置皮下 ,同时行病肝切除术。结果 4 4例得到随访 ,随访率 92 % ,随访 1～ 9年 ,平均 5年。结石复发率 2 0 % (9/ 4 4 ) ,胆管炎发生率 16 % (7/ 4 4 ) ,其中 7例行小切口切开皮下通道引流取石。结论皮下通道型肝胆管狭窄成型术与病肝切除联合应用可降低胆管炎发生率 ,为再发结石处理提供了一永久通道。更多还原

【Abstract】 Objective To enhance therapeutic effects of hepatolithiasis by improving surgical procedures. Methods Forty eight patients suffering from hepatolithiasis with bile duct stricture were treated in this study, in whom 27% (13/48) of the stone was located in the left lobe, 19% (9/48) in the right, and 54% (26/48) in bilateral lobe. Stone coexisted with stricture in 71% (34/48). Hepatic duct and stricture were opened, making a basin at the porta, and repaired by one end of a segment of jejunum. The other end was set subcutaneously. At the same time, a portion of the liver habouring stone was resected. Results Forty four out of 48 patients were followed up (92%) with an average of 5 years. The rate of recurrent stone was 20% (9/44), the rate of cholangitis was 16% (7/44), and 84% of cases fared very well. Postoperatively, 7 cases underwent lithotomy by choledochoscope through the subcutaneous blind loop. Conclusion This procedure decreases the relapsing cholangitis effectively.更多还原