肝内胆管结石并肝萎缩肥大征32例的诊治  

Diagnosis and treatment of intrahepatic stone complicated with atrophy-hypertrophy complex

作　　者：吴金术[1] 彭创[1] 谭正[1] 易为民[1] 

机构地区：[1]湖南省人民医院暨湖南师范大学第一附属医院肝胆外科,长沙410005

出　　处：《中华普通外科杂志》2017年第10期839-842,共4页Chinese Journal of General Surgery

基　　金：湖南省卫生厅科研基金资助项目（B2007136）;湖南省科技厅科技计划基金资助项目（2009SK3079）

摘　　要：目的探讨肝内胆管结石并肝萎缩肥大征的分型及手术方式。方法回顾性分析2014年1月至2015年12月湖南省人民医院手术治疗的32例肝胆管结石并肝萎缩肥大征患者的临床资料．总结肝萎缩肥大征的临床分型方案及相关手术方式。结果本组32例患者占同期我科收治肝胆管结石的1．9％，根据肝萎缩和肥大的部位将肝萎缩肥大征分为五型，其中Ⅱ型最多见，占本组38％。对不同类型肝萎缩肥大征患者，采取与之相应手术方式，配合术中胆管镜检查、碎石、取石，可将残石率降至6％。结石肝萎缩致残肝肥大，一级肝门移位，胆汁排除不畅、结石形成引起胆管炎反复发作的现象称为“花瓶效应”，采用肝胆管空肠双口内引流术可有效治疗。所有病例均获得随访，随访时间为12。36个月，全组无死亡病例，手术效果总优良率达94％。结论肝胆管结石合并肝萎缩肥大征综合应用CT、MRI和B超可明确诊断，根据肝萎缩肥大征的分型选择相应的手术方式可以减少残石率、提高患者生存质量。Objective Toexplore the typing and surgical methods on intrahepatic stone complicated with atrophy-hypertrophy complex. Methods The clinical data of 32 cases of intrahepatic stone complicated with atrophy-hypertrophy complex from January 2014 to December 2015 in HuMan Province Peopole＇s Hospital were retrospectively analysed. Results These 32 cases of atrophy-hypertrophy compIex accounted for 1.9% of admitted hepatolith patients. We divided the intrahepatic stone complicated with atrophy-hypertrophy syndrome into 5 types, and type- Ⅱ the most common. We performed operation combined with fiber choledochoscope to examine,smash and remove the stone. This methods could reduce the rate of residual stone to 6%. The liver will be partly atrophy with stones inside it, and the residual liver will become hypertrophy. Stones of intrahepatic bile duct lead to the change of the position of porta hepatis and straitness of primary bile duct, and the bile cannot smooth out. there will be lithogenesis and relapsing cholangitis. Patients were treated by intrahepatic biliary double-opening drainage, and followed-up for 12 -36 months. There were no death cases, and the total effective rate was 94%. Conclusions Intrahepatic stones complicated with atrophy-hypertrophy complex could be diagnosed by CT scan. Selecting proper operation method to treat atrophy-hypertrophy complex may decrease residual stones and improve the quality of life.

关 键 词：胆结石 胆管 肝内 肝萎缩肥大征 

分 类 号：R657.42[医药卫生—外科学]