复杂性肝内胆管结石外科治疗的临床体会  

Clinical Experience of Surgical Treatment for the Complex Hepatolithiasis

作　　者：杜丰杰[1] 李森[2] 孙洪强[1] 徐洋[1] 丁维宝[2] 

机构地区：[1]潍坊医学院临床学院,山东潍坊261053 [2]潍坊医学院附属潍坊市人民医院肝胆外科

出　　处：《潍坊医学院学报》2010年第3期205-207,共3页Acta Academiae Medicinae Weifang

摘　　要：目的探讨复杂性肝内胆管结石的诊疗方式。方法对30例原发或复发的肝胆管结石病人的临床资料进行回顾性分析。结果30例中行肝左外叶切除6例，左半肝切除7例，肝Ⅳ段切除术3倒（肝左外叶已切除者），右半肝切除术2例，右后叶切除术5例，肝Ⅱ、Ⅲ段＋部分肝Ⅳ段及肝Ⅵ＋部分肝Ⅶ切除术1例，胆肠Roux-en-Y端侧吻合术4例（3例为原吻合口狭窄），单纯胆总管切开取石＋T管引流术2例，行胆总管置T管引流术15例。全组病人无手术死亡，并发症发生率23．33％，结石残余率10．00％，30例中获术后随访25例，随访时间1年～60个月，平均（36．7±13．9）个月，随访期间未发现胆道结石复发，2例胆肠吻合术后病人曾有急性胆管炎发作，予抗感染治疗后缓解，未再次手术治疗。结论选择合适的肝切除术式对治疗复杂性肝胆管结石是确实有效的，可显著降低术后残石率，安全可行。Objective To investigate the way to diagnose and treat complex hepatolithiasis. Methods Clinical data of thirty cases of primary or recurrent hepatolithiasis were analyzed retrospectively. Results In 30 cases ,6 cases were treated with hepatic left lateral lobectomy,7 cases with left hemihepatectomy,3 with resection of liver segment IV （ left lateral lobe of liver had been reseeted） ,2 cases with right hemihepatectomy ,5 cases with right posterior lobectomy, only 1 case of the left lateral lobectomy combined with partial liver segment IV resection and liver segment VI resection combined with partial liver segment VII resection ,4 cases with end-side Roux-en-Y eholangio-enterostomy （ 3 cases were anastomotic stricture of the original） , single-Choledocholithotomy with T-tube drainage in 2 cases,T-tube drainage of common bile duct in 15 cases. The whole group of patients has no operative mortality,postoperative complication rate was23.33% ,stone residual rate was 10.00%. Twenty-five cases were followed up for 12 - 60 months （ mean = 36.7 ± 13.9 ）. During follow-up,there was no stone recurrence. Two patients with biliary-enteric anastomosis experienced acute cholangitis,whieh was controlled by the anti-infective treatment,without further surgery. Conclusion Selecting appropriate type of liver resection for treatment of complex hepatolithiasis is real effective, feasible and safe ,and can significantly reduce the residual stone rate.

关 键 词：复杂性肝胆管结石 肝切除术 并发症 

分 类 号：R575.7[医药卫生—消化系统]