经Glisson鞘美蓝染色解剖性肝切除治疗右肝后叶胆管结石  

Anatomical liver resection by trans-Glisson sheath methylene blue staining for treatment ofhepatolithiasis of right posterior lobe

作　　者：严茂林[1] 游燊[1] 陈忠[1] 王耀东[1] 陈志江[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院肝胆外科,福州350001

出　　处：《中华普通外科杂志》2013年第11期826-828,共3页Chinese Journal of General Surgery

基　　金：福建省卫生厅医学创新课题基金资助项目（2009-CBX-11）;福建省卫生厅青年基金资助项目（2207-41）

摘　　要：目的探讨经Glisson鞘美蓝染色解剖性肝切除治疗右肝后叶胆管结石的有效性及技术要点。方法回顾性分析收治的12例经Glisson鞘美蓝染色解剖性肝切除治疗右肝后叶胆管结石的临床资料。结果12例患者中，6例为2次以上胆道手术者。全部患者均行肝CT增强扫描及门静脉成像，单纯右肝Ⅵ段胆管结石4例，右肝后叶胆管结石8例，伴左肝外侧叶胆管结石2例、右侧尾状叶胆管结石1例。分离肝Ⅵ段或右肝后叶Glisson鞘，经门静脉注入美蓝，肝Ⅵ或右肝后叶美蓝界面显示良好。美蓝界面比缺血界面大且符合解剖。沿美蓝界面Ⅵ、Ⅶ段联合切除9例，Ⅵ段切除3例，合并左肝外侧叶切除2例、右侧尾状叶切除1例。术后切口感染5例、右胸腔积液4例、胆瘘2例，均保守治疗后痊愈，术后无死亡病例。所有患者获得3个月至7年（平均3．2年）随防，无结石复发。结论经Glisson鞘美蓝染色解剖性肝切除是右肝后叶胆管结石安全而有效的治疗措施。熟悉Glisson鞘的解剖和紧贴Glisson鞘分离是避免损伤胆管或门静脉的有效办法。Objective To investigate the effectiveness and technical points of anatomical liver resection by trans-Glisson Sheath methylene blue staining in treatment of hepatolithiasis of right posterior lobe. Methods The clinical data of 12 cases of hepatolithiasis of right posterior lobe treated with anatomical liver resection by Glisson sheath methylene blue staining were retrospectively analyzed. Result 6 of 12 patients had undergone more than 2 previous biliary surgeries. All patients underwent contrast-enhanced CT scan and portography, hepatolithiasis of segment VI in 4 cases, right posterior lobe in 8 cases, accompanied by left lateral lobe bile duct stones in 2 cases, the right caudate lobe bile duct stones in 1 case. Methylene blue was injected into the portal vein, the methylene blue interface of segment VI or right posterior lobe displays well. Methylene blue interface was larger than the ischemia interface, which is in accordance with the anatomy. Along the methylene blue interface, hepatic resection was performed including right posterior lobe resection （ n = 9 ）, segment Ⅵ resection （ n = 3 ）, and combined with left lateral lobe resection （ n = 2 ） and the right caudate lobe resection （ n = 1 ）. There was no postoperative mortality. Incision infection occurred in 5 cases, 4 had right pleural effusion and 2 had a biliary fistula that were treated conservatively. With a mean follow-up period of 3.2 years, all patients are symptoms free and stone free. Conclusions Anatomical liver resection by methylene blue staining is a safe and effective treatment for hepatolithiasis of right posterior lobe.

关 键 词：胆结石 肝切除术 Glisson鞘 

分 类 号：R657.3[医药卫生—外科学]