区域胆管、肝动脉、门静脉联合阻断治疗肝内胆管良性疾病的初步应用  

Primary Experiences of Regional Bile Ductal and Vascular Occlusion for Regional Intrahepatic Bile Duct Diseases

作　　者：李锦貌 喻家奎 陈立波[3] 翟荣林[3] 宋孟锜[3] 由法平[3] 

机构地区：[1]湖北省恩施自治州中心医院肝胆胰脾外科,恩施430000 [2]湖北省恩施州宣恩县民族医院普外科,恩施4300001 [3]华中科技大学协和医院肝胆外科,武汉430022

出　　处：《中国现代手术学杂志》2011年第4期245-248,共4页Chinese Journal of Modern Operative Surgery

基　　金：教育部新世纪优秀人才支撑计划(NCET-07-318)资助

摘　　要：目的探讨区域胆管和供应血管联合阻断在难治性肝内胆管疾病治疗中的价值。方法 2007年3月～2010年5月对17例右肝内胆管结石7、例肝内型先天性胆管囊肿开展区域胆管和供应血管阻断治疗。对肝内胆管结石行肝内胆管切开取石、胆管注入封闭胶和区域胆管、肝动脉、门静脉阻断;对肝内型胆管囊肿经肝门分离病变胆管开口注入封闭胶后行区域动脉、门静脉、胆管阻断。所有患者术后3 d1、周2、周复查肝功能,术后2周、1月、6月、1年行肝脏B超或CT随访。结果所有病例无肝衰、大出血、胆漏、严重感染等严重围手术期并发症;术后2周行肝脏B超或CT检查示病灶明显缩小或消失;术后1月和6月复查肝脏CT示病灶完全消失,病灶所在肝脏萎缩消失,残余肝脏代偿增生。结论通过病变区域胆管、肝动脉、门静脉联合阻断治疗某些难治性区域性良性肝内胆管疾病,可以达到较彻底的治疗效果,且能有效降低对患者的创伤,减少围手术期严重并发症的发生,明显提高该类患者的手术安全性。Objective To evaluate the role of regional ductal and vascular occlusion in treating intrahepatic bile duct diseases. Methods 17 cases of hepatolithiasis and 7 cases of type ⅣorⅤ congenital dilation of bile duct received regional bile ductal and vascular occlusion from March 2007 to May 2010. Peri-oPerational complications were recorded and follow-up were applied with B-ultrasound or CT at 2 weeks, 1 month, 6 months and 1 year post-operatively. Results All cases accepted successful regional ductal and vascular occlusion. No severe post-operative complication occurred. Follow-up CT or ultrasound at 2 weeks after operation showed disappearance or massive reduction of managed hepatic region. CT or ultrasound scan at 1 mouth and 6 months post-operatively showed clearance of managed hepatic region with residual hepatic regeneration. Conclusions Combined regional ductal and vascular occlusion is effective to treat regional hepatolithiasis, congenital dilation of intrahepatic bile duct and other benign regional intrahepatic bile duct diseases, With safety for these patients.

关 键 词：肝内胆管结石 胆管扩张 胆管阻断 血管阻断 

分 类 号：R657.4[医药卫生—外科学]