肝胆管结石并发门静脉高压的外科处理  

Operation treatment of hepatol ithiasis with hepatocirrhosis and portal hypertension

作　　者：魏立平[1] 

机构地区：[1]山东省新泰市人民医院外一科,271200

出　　处：《中国实用医药》2008年第6期24-25,共2页China Practical Medicine

摘　　要：目的总结和探讨肝胆管结石症合并肝硬化门脉高压的临床特点和处理方法。方法报告32例胆石症并胆汁性肝硬化门静脉高压症的外科手术治疗情况。结果本组病例治愈27例,死亡5例,病死率为15.6%。其中2例患者均因经济原因主动放弃治疗,分别死于肝功能衰竭、上消化道出血,2例死于术后肝功能衰竭,1例因同时合并重症化脓性胆管炎,于术中死于感染中毒性休克,多器官功能衰竭。结论采取分期手术解除胆管梗阻,尽量取尽残石,建立充分的胆管内或外引流,积极护肝治疗,改善肝功能,积极控制并发症是降低胆石症并胆汁性肝硬化门静脉高压症病死率的关键。Objective To investigate operation treatment and summarize clinical features of hepatolithiasis with hepatocirrhosis and portal hypertension. Methods Surgical treatment conditions were summarized in 32 patients with calculi in the intra-and extra-hepatic ducts complicating biliary cirrhosis with portal hyperten- sion. Results Of all 32 cases treated,27 were cured and the other 5 dead,with a case fatality of 15.6% ,and among whom 2 actively withdrawn treatment due to financial straits,and subsequently died of liver function failure and upper gastrointestinal hemorrhage, 1 died from post-operative liver function failure ,and the remaining 1 died of infectious-toxic shock and multiple organ failure during operation owing to concurrent severe suppurative cholangitis. Conclusion Selection of staging operation to eliminate obstruction of bile duct, removing residual calculi to the limit,establishing the sufficient drainage in the intra-and extra-biliary tracts,active protection and preservation of the liver, improving liver function, and positively rescuing complications prove to be the key to reducing the case fatality of calculi in the intra-and extra-hepatic ducts complicating biliary cirrhosis with portal hypertension.

关 键 词：肝胆管结石 肝功能分级 门脉高压 

分 类 号：R657.4[医药卫生—外科学]