肝内胆管结石82例手术治疗体会  

Surgical treatment of hepatolithiasis： A report of 82 cases

作　　者：李哲夫[1] 乔显森 吴志超[1] 张旭[1] 史成宇[1] 乔晟先 王海全[1] 李勇[1] 

机构地区：[1]青岛市中心医院肝胆外科青岛大学医学院第二附属医院肝胆外科,青岛266042

出　　处：《腹部外科》2015年第5期333-336,共4页Journal of Abdominal Surgery

摘　　要：目的 总结肝内胆管结石手术治疗的效果.方法 回顾性分析2005年1月至2015年1月收治的82例肝内胆管结石,双侧肝胆管结石40例,占48.8％（40/82）;左肝胆管结石27例,占32.9％（27/82）,包括左肝外叶（Ⅱ、Ⅲ段）胆管结石20例,左半肝（Ⅱ、Ⅲ、Ⅳ段）胆管结石7例;右肝胆管结石15例,占18.3％（15/82）.82例肝内胆管结石合并肝脓肿5例,占6.1％（5/82）;左肝胆管囊腺癌2例,占2.4％（2/82）;终末期胆病2例,占2.4％（2/82）;合并胆总管结石32例,占39.0％（32/82）.结果 肝段或多肝段切除术64例,占全部手术78.0％（64/82）;其中合并胆总管切开取石32例,胆总管切开探查3例,分别占肝段切除术的50.0％（32/64）和4.7％（3/64）;2例行原位肝移植;其余16例行Ⅳb（肝方叶）切除＋胆总管及一、二级胆管切开取石,其中9例行胆管切开取石或成形后T管引流,7例行胆肠吻合术.随访时间为6～18个月.本组并发症发生率为24.4％（20/82）,其中胸腔积液4例,肺部感染2例,腹腔积液3例,切口感染3例,胆漏2例,残余结石1例;并发胆管炎2例,术后结石复发3例,无手术死亡.结论 肝段或多肝段切除是治疗肝内胆管结石的最有效手术方式,肝方叶切除联合一、二级胆管切开取石或行狭窄胆管成形后T管引流,狭窄的胆管切除后行胆肠吻合术亦可以取得良好的治疗效果.Objective @o summarize our experience and evaluate the therapeutic efficacies of surgical treatment for hepatolithiasis. Methods The surgical procedures and efficacy of the 82 cases of hepatolithiasis from Jan. 2005 to Jan. 2015 were retrospectively analyzed, including 40 cases of hepatolithiasis in both right and left lobes of liver, accounting for 48.8% （40/82） % 27 cases of hepatolithiasis in both left lateral lobes （ Ⅱ and Ⅲ segments, 20 cases） and left lobe （ Ⅱ , Ⅲ, and Ⅳ segments, 7 cases） of liver, accounting for 32. 9% （27/82）, and 15 cases of hepatolithiasis in right lobe of liver, accounting for 18. 3% （15/82）. There were 5 cases of hepatolithiasis combined with liver abscess, 2 cases of hepatolithiasis combined with left intrahepatic adenocarcinoma, 2 cases of end-stage of hepatolithiasis and 32 cases of hepatolithiasis combined with choledocholithiasis, accounting for 6. 1 % （5/ 82）, 2. 4% （2/82）, 2. 4% （2/82） and 39. 0% （32/82） respectively. Results Sixty-four cases in this group were given segmentectomy or multiple segmentectomy, accounting for 78. 0%, including 37 cases of segmentectomy combined with choledochotomy for stone removal and 3 cases of segmentectomy combined with choledochotomy for exploration, accounting for 50. 0% （32/64） and 4. 7% （3/64） respectively. Two cases of end-stage of hepatolithiasis underwent orthotopic liver transplantation. The remaining 16 cases underwent resection of quadrate lobe, and incision of common bile duct, Ⅰ and Ⅱ grade bile duct for stones removal, of which 9 cases were subjected to T-tube drainage, and 7 cases received choledochojejunostomy. Postoperative complications occurred in 20 cases （24. 4%）, including 4 cases of pleural effusion, 2 cases of pulmonary infection, 3 cases of ascites, 3 cases of wound infec- tion, 2 cases of bile leakage, 1 case of residual calculi, 2 cases of cholangitis and 3 cases of recurrent hepatolithiasis. Conclusions Hepatic segmentectomy or multiple segmentectomy was t

关 键 词：肝内胆管结石 肝切除 胆肠吻合 外科治疗 

分 类 号：R657.46[医药卫生—外科学]