合并胆汁性肝硬化门静脉高压的肝内外胆管结石治疗探讨  

Combined biliary cirrhosis portal hypertension calculus of bile duct of liver inside and outside of the treatment

作　　者：董家刚[1] 庞显伦 

机构地区：[1]宜宾市第三人民医院,四川宜宾644000 [2]西南医科大学附属中医院,四川泸州646000

出　　处：《基层医学论坛》2017年第32期4450-4452,共3页The Medical Forum

摘　　要：目的探讨合并胆汁性肝硬化门静脉高压症肝内外胆管结石患者的治疗方法。方法分析我院2011年—2016年收治的27例合并胆汁性肝硬化门静脉高压症肝内外胆管结石患者的临床资料。结果取净肝内外结石后,胆总管外引流11例,肝叶切除(左外叶切除6例,左半肝切除2例,右半肝切除2例)胆管外引流10例,左或右肝管外引流5例。肝门胆管经整形后空肠Roux-en-Y吻合1例,并行脾动脉结扎2例,并行断流术1例,本组患者未行分流术。27例中发生9种近期并发症,2例死亡,其余经治疗痊愈。结论合并胆汁性肝硬化门静脉高压症的肝胆管结石外科治疗时存在较高的手术风险,需设计个体化手术方案,并可能联用多种治疗方式,其中出血和肝功能衰竭是术后死亡的主要原因。Objective To investigate the rational treatment methods of intrahepatic and extrahepatic bile duct stones associated with the combined Biliary cirrhosis with hypertension. Methods The clinical data of 27 patients of intrahepatic and extrahepatic bile duct stones associated with PBCH treated in our hospital from 2011 to 2016 were analyzed and summarized. Results 11 cases of external drainage of bile duct,hepatic lobectomy（left outer lobe resection in 6 cases,left hepatectomy in 2 case,right hemihepatic resection in 2 cases）Tube drainage in 5 cases were performed after complete removal of internal and external stones. Roux-en-Y anastomosis of jejunum after hilar bile duct resection was performed in 1 case. Splenic artery ligation was performed in 2 cases. One case of disconnection was performed concurrently. Portal venous shunt was not performed in this group. 9 patients had recent complications and 2 had died,and the rest had been cured among the 27 patients. Conclusion Surgical treatment of intrahepatic and extrahepatic bile duct stones associated with PBCH is with high risks when treated. Individual surgical procedures are needed to design. And may be combined with a variety of treatment.Hemorrhage and liver failure are the main causes of postoperative death.Dong Jiagang1, Pang Xianlun 2. 1 The Third People＇s Hospital of Yibin City, Yibin, Sichuan 644000; TheAffiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000

关 键 词：胆汁性肝硬化 门静脉高压症 肝内外胆管结石 手术治疗 

分 类 号：R657.42[医药卫生—外科学]