【摘要】 目的总结肝胆管结石外科诊治及其术后并发症预防的临床经验。方法回顾性分析136例肝胆管结石患者辅助检查诊断的准确性、手术方案选择的合理性及治疗效果。结果136例患者,101例术前单独行B超(56例)或CT(45例)检查,35例联合B超和CT进行术前检查。两组患者术前辅助检查诊断与术中符合率分别为84.2%和94.3%。单侧肝胆管结石患者术后引流与未引流结石残留率相似,双侧肝胆管结石行肝段/肝叶切除+高位胆管切开取石+术后胆道镜取石,结石残留率明显低于单纯肝段/肝叶切除或高位胆管切开取石术患者。结论(1)B超联合CT检查在肝胆管结石患者中诊断准确率高于单独B超或CT检查;(2)以切除含病灶的肝段或肝叶为主的手术方案在单侧肝胆管结石患者中效果较好,且患者可无需引流;(3)在双侧肝胆管结石患者中,肝段/肝叶+高位肝胆管切开取石+术后胆道镜取石的治疗效果最好。更多还原

【Abstract】 Objective To summarize the clinical experiences of diagnosis and treatment of hepatolithiasis and the prophylaxis of postoperative complications. Methods The clinical data of 136 cases were analyzed retrospectively. Results 56,45 and 35 patients undertook B-mode ultrasound,computer tomography (CT) and the combination of B-mode ultrasound and CT,respectively. The accuracy rates of B-mode ultrasound or computer tomography (CT) alone and the combination of B-mode ultrasound and CT were 84.2% and 94.3% respectively. There was no difference of the residual stone incidence between patients who had unilateral hepatolithiasis and undertook hepatobiliary drainage or not after operation. Patients who had bilateral hepatolithiasis and undertook the combination of lobe/segment hepatectomy and high location hepaticolithotomy,have prominent lower incidence of residual stone than those who have only undertook lobe/segment hepatectomy or high location hepaticolithotomy with postoperative choledochoscopy examination.Conclusion (1) The combination of B-mode ultrasound and CT has a higher accuracy rate than B-mode ultrasound or CT alone in the diagnosis of hepatolithiasis. (2) It is preferable to perform hepatectomy in the only one side of hepatolithiasis without hepatobiliary drainage after operation. (3) It is best to undertake the combination of lobe/segment hepatectomy and high location hepaticolithotomy as well as postoperative choledochoscopy examination in patients who have bilateral hepatolithiasis.更多还原