皮下通道胆囊肝胆管成形术治疗肝内胆管结石  

Subcutaneous Tunnel and Hepatocholangioplasty Using the Gallbladder for Hepatolithiasis

作　　者：谷建斌[1,2,3] 徐智[1] 王立新[1] 侯纯升[1] 凌晓锋[1] 周孝思[1] 

机构地区：[1]北京大学第三医院普外科,北京100191 [2]北京大学医学部 [3]石家庄市第一医院外二科,石家庄050011

出　　处：《中国微创外科杂志》2009年第4期336-338,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨皮下通道胆囊肝胆管成形术治疗肝内胆管结石的效果。方法2001年6月～2008年5月,采用皮下通道胆囊肝胆管成形术治疗肝内胆管结石43例。在清除结石、解除肝内外胆管狭窄、肝门整形的基础上,利用胆囊壶腹部切开相应大小的切口与切开的胆管吻合,并适当游离胆囊,使其底部可以被固定到切口皮下。要求术中基本取尽肝内结石或切除病灶。结果同时行肝切除18例(41.9%)。术后残石率39.5%(17/43)。该术式联合肝切除与未联合肝切除的残石率分别为27.8%(5/18)、48.0%(12/25)。术后出现1例胆漏,1例真菌感染。43例随访1～83个月,平均27.6月。再发胆管炎和结石3例,胆管炎发作1例,再发结石1例,均通过皮下通道切开引流、取石而治愈。结论皮下通道胆囊肝胆管成形术治疗肝内胆管结石安全、有效、微创、简便。Objective To assess the efficacy of subcutaneous tunnel and hepatocholangioplasty using the gallbladder （STHG） in the treatment of hepatolithiasis. Methods A retrospective analysis was done on 43 patients with hepatolithiasis who underwent STHG between June 2001 and May 2008. The strictured bile duct at the hilus was opened after removing the stones or cutting the damaged liver segments. The gallbladder was anastomosed to the widely opened bile duct in the hilus to form a widened pass way through the intrahepatic to the extrahepatic ducts. And the fundus of the gallbladder was mobilized and pulled to the abdominal wall to form a subcutaneous tunnel as a re-entry to the biliary tree. Results Totally 18 patients （41.9%） underwent resection of the liver,17 patients （39.5%） had residual stones. The rate of residual stone was 27.8% （5/18） in those treated by STHG combined with hepatectomy,and 48.0% （12/25） in those received STHG only. One patient developed biliary leakage and 1 patient had fungous infection after the operation. The 43 patients were followed up for a mean of 27.6 months （range,1-83）. During the period,3 patients had recurrence of cholangitis and hepatolithiasis,1 showed cholangitis,and 1 had recurrent stones. The recurrent cases were cured by drainage or removing the stones through the subcutaneous tunnel. Conclusion STHG is safe,effective,minimally invasive and easy to manipulate for the treatment of hepatolithiasis.

关 键 词：肝内胆管结石 胆囊 皮下通道 

分 类 号：R657.4[医药卫生—外科学]