Cheung M T
Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Br J Surg. 1997 Sep;84(9):1224-8.
The management of primary intrahepatic stones is extremely difficult. During operation it is often difficult to remove all the stones. The postoperative T tube tract provides an invaluable access to the intrahepatic system.
This paper reports a retrospective review of postoperative choledochoscopic removal of intrahepatic stones in a series of 44 patients. Special emphasis is placed on the result of the procedure and on the long-term outcome of patients.
Overall, the procedure was successful in 22 of the 44 patients. Presence of strictures was associated significantly with failure rate (P = 0.002). There were complications in five patients; most subsided with conservative management. However, there was one procedure-related death in the series. Some 28 patients were followed for 16-115 months. The long-term outcome was significantly related to the success rate of choledochoscopic stone removal (P = 0.03).
All intrahepatic stones should be removed. T tube choledochoscopy is the preferred method for treating retained intrahepatic stones. This should be supplemented with other modalities of treatment, such as endoscopic and radiological approaches, especially in patients with strictures.
原发性肝内胆管结石的治疗极具挑战性。手术中往往难以清除所有结石。术后的T管窦道为进入肝内系统提供了宝贵的途径。
本文对44例患者术后经胆道镜清除肝内结石进行回顾性研究。重点关注手术结果及患者的长期预后。
总体而言，44例患者中有22例手术成功。狭窄的存在与失败率显著相关（P = 0.002）。5例患者出现并发症；多数经保守治疗后缓解。然而，该系列中有1例与手术相关的死亡病例。约28例患者随访了16至115个月。长期预后与经胆道镜取石成功率显著相关（P = 0.03）。
应清除所有肝内结石。T管胆道镜检查是治疗残留肝内结石的首选方法。尤其对于有狭窄的患者，应辅以其他治疗方式，如内镜和放射学方法。
