摘要
目的探讨复杂肝内胆管结石取石技巧,尽量降低残石率。方法回顾性分析近四年来我院收治的复杂肝内胆管结石病例225例,术中首先用取石钳钳取胆总管、肝门部胆管结石,其次胆道镜检查胆道系统,确定取石策略。然后应用取石钳钳取、胆道镜取石网篮套取、活检钳咬碎、冲击波碎石、脉冲式冲洗等多种方法联合取石,部分病人结合肝叶切除、胆肠吻合等术式。结果行胆道引流术者(含肝叶切除术)201例行T管造影结石取尽133例,结石取尽率66.2%(133/201)。行胆肠吻合术者4例术后残余结石伴胆管炎。无死亡病例。结论肝内胆管复杂结石治疗棘手,术前应准备充分、准确评估、术中遵循基本手术原则、联合多种方法取石,争取获得最佳手术效果。
Objective To study strategy of taking out stones in complicated intrahepatic stones. Methods A retrospective clinical analysis was made in 225 cases with complicated intrahepatic stones in resent 4 years. First, lithotomy forceps were used for common bile duct stones and primary phpatic duct stones. Second choledoehoseope was used to check biliary system, methods of lithot- omy was decided. Lithotomy forceps, biopsy forceps, stone extrator, shockwave lithotripsy, impulse type flush, etc were used alter- nately. Liver resection and biliary intestinal anastomosis were combined in part of cases. Results 133 cases of complicated intrahepat- ic stones were taken all by T tube imaging in 201 cases, the rate of taking all was 66.2% （ 133/201 ）. 4 cases of residual calculi appear cholangitis after biliary intestinal anastomosis, no deaths. Conclusion Treatment of complicated intrahepatic stones was tricky, we should ready fully, evaluate fully before operation, basic operative principle should be followed and a variety methods of taking out stones should be combined to obtain the best effect of operation.
作者
时吉庆
秦红军
李俊
胡红强
肖青川
陈炯
罗伟
SHI Ji-qing QIN Hong-jun LI Jun et al(Sichuan General Team Hospital of Chinese People＇ s Armed Police Forces, Leshan 614000, China)
出处
《肝胆外科杂志》
2016年第6期462-463,465,共3页
Journal of Hepatobiliary Surgery
关键词
复杂肝内胆管结石
取石策略
complicated intrahepatic stones
treatment strategy
