肝内胆管结石112例手术治疗.doc

肝内胆管结石112例手术治疗 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：肝内胆管结石112例手术治疗 1 1　资料与方法 2 2　结果 3 3　讨论 3 文2：手术治疗肝内胆管结石临床体会 5 1 资料与方法 7 参考文摘引言： 7 原创性声明（模板） 8 文章致谢（模板） 9 正文 肝内胆管结石112例手术治疗 文1：肝内胆管结石112例手术治疗 【ABSTRACT】 Objective: To investigate the surgical treatment of patients with intrahepatolithiasis and therapeutic strategy of residual stone. Methods: 112 patients with hepatolithiasis were reviewed and analyzed retrospectively. 29 cases received hepatolobectomy(hepatic segmentectomy),8 cases received hepatolobectomy(hepatic segmentectomy) plus Roux-en-Y cholangiojejunostomy, 6 cases received hepatolobectomy(hepatic segmentectomy) plus choledochotomy and calculus removal, 20 cases received hepaticolithotomy plus Roux-en-Y cholangiojejunostomy and simple choledochotomy and calculus removal plus T-tube drainaged were applied in 49 cases. Results: 28 cases(25%) had residual stone after surgical treatment, 4 cases(%) had residual stone after calculus removed with choledochoscope, 2 cases(%) received operation again. Conclusion: The rate of residual stone was %, It is essential to release obstruction and remove the cause in the treatment of patter of operation should be chosen according to different situation, and choledochoscope plays an important role in the improvement of surgical results and lowering of postoperative complication rate. 【KEY WORDS】 Intrahepatolithiasis· Intrahepatolithiasis·Surgical procedures, operative 肝内胆管结石是指发生于肝管汇合部以上的肝管内结石，其病程长，反复发作，手术难度大，残石率高。如何取尽结石、减少残石率、降低手术并发症、预防复发一直是胆道外科的重点和难点[1]。本文 总结 我院2002年1月—2008年7月手术治疗肝内胆管结石112例，报道如下。 1　资料与方法 一般资料　本组112例中，男51例，女61例，男女比例1︰。年龄20～88岁，平均年龄55岁。主要症状为右上腹痛101例(%)，发热69例(%)，黄疸58例(%)。病程3个月～20年。有胆管炎病史者73例(%)，1次胆道手术史者21例(%)，2次者11例(%)，3次者5例(%)。所有患者均经B超、CT或MRCP等检查确诊，单纯左肝内胆管结石32例(%)，单纯右肝内胆管结石24例(%)，左右肝内胆管结石56例(%)，合并胆囊结石27例(%)，合并胆总管结石60例(%)，合并胆管狭窄 48例(%)。肝功能Child分级A级65例(%)，B级33例(%)，C级14例(%)。全组均经手术治疗，经手术探查证实均有肝内胆管结石，合并肝外胆管结石者74例(%)，合并胆囊炎29例(%)，合并胆道感染28例( 手术方法　肝叶(段)切除术29例(%)，其中左肝外叶切除加T管引流18例(%)，左半肝切除加