【摘要】 目的　总结 2 0年来肝胆管结石 (IHS) 2 80例外科治疗的变迁和疗效 ,探索如何抉择更合理的术式。方法　归纳 2 80例外科治疗 :急诊和择期单纯胆 (肝 )总管切开取石和引流 (CS) 110例 ;CS加术中、术后纤维胆道镜检和取石 (FC) 4 8例 ;胆肠内引流 (BED) 6 8例 ;肝切除 (HL) 35例 ;联合手术 (CO) 19例 ,后 4组以择期为主。结果　CS及BED疗效较差 ;CS加FC及HL和CO有较好效果。结论　处理IHS对肝胆系应具整体观念。CS难以有效 ,多需后续治疗 ;加用FC简易微创、安全有效 ;BED存有一些难免的并发症 ,指征应从严 ;HL切除了病灶而效果好 ;CO对肝胆广泛病变系有针对性术式 ,疗效亦较好。更多还原

【Abstract】 Objective To summarize the changes and therapeutic efficacy of surgical treatments in 280 cases of intra-hepatic bile duct stone (IHS) in the past 20 years and explore the selection of more reasonable operative approaches. Methods The surgical treatment for 280 cases of IHS in the past 20 years were summarized. Of these 280 patients, 110 patients received emergency and eletive choledochostomy (CS), 48 CS plus intra- and postoperative fibrocholedochoscopic management (FC), 68 bilio-enteric drainage (BED), 35 hepatic lobectomy (HL) and 19 combined operation (CO). Most of the operations in the latter 4 groups were selectively performed. Results The therapeutic effects of simple CS and BED were poor while those of CS plus FC, HL and CO were better. Conclusions In treatment of IHS, the liver and biliary system should be considered as a whole. CS alone is not effective in treatment of IHS and the condition of the patients can be improved by supplementary methods. Meanwhile, further postoperative management including reoperation is usually needed. BED often results in some unavoidable complications. Thus the indications for BED should be strictly chosen. CS plus FC is simple, minitraumatic, safe and very effective. HL is effective because it removes the foci. CO is a good operation for widespread lesions of hepatobiliary system and can achieve satisfactory results.更多还原