异位汇合肝胆管的外科问题及其处理(附6例临床分析)  

The Surgical problems and management of ectopic confluence of hepatic ducts(a report of 6 cases).

作　　者：郑光琪[1] 

机构地区：[1]华西医科大学附属第一医院普外科

出　　处：《中国实用外科杂志》1999年第4期211-213,共3页Chinese Journal of Practical Surgery

摘　　要：目的介绍１～３级肝管异位汇合诊治体会。方法诊断①合并肝管结石者经高位肝管切开探查，②肝左叶切除切断左肝管后在肝断面上需再切断横向左行的肝管，③术中、术后胆管造影。发现右前下支肝管汇入胆囊、右后支、右前支、右前下支肝管汇入左肝管，右尾叶支汇入左尾叶肝管及右前支汇入左肝管伴左外上、下支分裂各１例。结果合并肝管结石用取石和加大汇入角治疗效果不佳，切除含石的异位汇合肝管的肝叶、肝段；肝左叶切除后将异位汇合的肝管与右肝管或与空肠袢接通效果较好。结论胆囊切除需注意左、右肝管与胆囊管在同一平面低位汇合，右肝管结石，肝左叶切除。Objective To present the preliminary experience in management of ectopic confluence of 1～3 grade hepatic duct.Methods Diagnosis depends on ①operative exploration via a high incision in hepatic duct(HD)for hepatolithiasis in right side,②a tranversely coursed HD has to cut down after the left hepatic duct(LHD)severed in left hepatic lobectomy(LHL),③operative or postoperative cholangiography.The inferior branch of right anterior HD(IARHD)drained in gallbladder,posterior,anterior branch of right hepatic duct(RHD)and IARHD joined the LHD,right caudal hepatic duct(CHD)drained in left CHD,anterior branch of RHD drained in LHD with split of superior and inferior branch of left lateral HD were revealed for each instance.Results The effect of lithotomy and widen the cofluence for hepatolithiasis is worse,resect the hepatic lobe or segment containing ectopic HD with stones,anastomose the ectopic HD with RHD after LHL get better result.Conclusion Pay attention to low confluence of RHD and LHD with cystic duct in cholecystectomy,to ectopic HD of RHD drained in LHD in right side hepatolithiasis,in LHL and in supplementary liver transplantation between relatives.

关 键 词：肝胆管 异位汇合 外科手术 诊断 

分 类 号：R657.3[医药卫生—外科学]