多肝段联合切除术在双侧复杂肝内胆管结石治疗中的合理应用  

Reasonable application of combined multi-segmental hepatectomy for complicated bilateral hepatolithiasis

作　　者：石刚[1] 李敬东[1] 陶涛[1] 雷俊阳[1] 严德辉[1] 

机构地区：[1]川北医学院附属医院普外科,四川南充637000

出　　处：《肝胆胰外科杂志》2010年第3期210-212,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的评价多肝段联合切除对双侧复杂肝内胆管结石的治疗效果。方法报告1990年1月至2008年12月间52例双侧肝内胆管结石采用多肝段联合切除治疗的效果、并发症及随访情况。结果 52例均采用多肝段联合切除+胆总管或肝总管切开探查+T管引流术的手术方式,术后并发症有胸腔积液15例(28.8%),切口感染7例(13.5%),大量腹腔积液5例(9.6%),膈下感染6例(11.5%),肝功能衰竭4例(7.7%),胆漏2例(3.8%),腹腔内感染2例(3.8%)。围手术期死亡3例,病死率为5.8%(3/52),死亡原因均为急性肝功能衰竭。术后T管造影发现7例存在肝内胆管残余结石,5例经胆道镜完全取出残余结石,结石清除率为95.9%(47/49)。48例获长期随访,平均随访41.3个月,5例术后结石复发,1例反复发作胆管炎,本组远期优良率达87.5%(42/48例)。结论双侧肝内胆管结石的病情复杂,治疗困难。多肝段联合切除可以同时清除双侧结石病灶,并解除胆管高位狭窄,达到根治性目的,疗效肯定,值得在临床上加以推广和应用。但此手术难度大,并发症发生率较高,故应采取个体化治疗的方案,结合术前检查和术中探查情况,选择性地在双侧肝内胆管结石的治疗中加以应用。Objective To evaluate the therapeutic effect of combined multi-segmental hepatectomy on thebilateral hepatolithiasis. Methods The clinical data of 52 patients sufferred from bilateral hepatolithiasis aftercombined multi-segmental hepatectomy was informed with the therapeutic effects, the complications and thepostoperative follow-ups from January 1990 to December 2008. Results After these 52 patients underwentcombined multi-segmental hepatectomy in combination with choledochotomy and T-tube drainage, the majorityof postoperative complications were pleural effusion （28.8%）, infection of incisional wound （13.5%）, a greatquantity of seroperitoneum （9.6%）, subphrenic infection （11.5%）, liver failure （7.7%）, biliary fistula （3.8%）,and intra-abdominal infection （3.8%）, while three patients （5.8%） died from liver failure during the hospitalization. Seven patients were found residual intrahepatic stones through T-tube cholangiography, among them fivepatients received free stone removal by choledochoscopic stone extraction. The total stone extraction rate is95.9% （47/49）. Long-term follow-up in 48 patients （98.0%） at a median of 41.3 months showed that the stonerecurrence occurred in 5 postoperative patients, one with repeated cholangitis and 42 patients （87.5%） wereasymptomatical. Conclusion Combined multi-segmental hepatectomy is an effective surgery for complicated bilateral hepatolithiasis, which not only makes the bilateral focus of bile duct stones clear, but also removesthe stricture of sublimis bile duct. This modus operandi should be recommended in clinic presently. However,it should be noted that the individual principle should be selectively applied to the treatment for bilateralhepatolithiasis owing to relative difficult manipulation and various complications.

关 键 词：双侧肝内胆管结石 多肝段联合切除 

分 类 号：R657.42[医药卫生—外科学]