肝门腹侧肝脏切除治疗复杂肝胆管结石并肝门狭窄16例疗效分析  

The effects of resection of the ventral segment of the hepatic portal for complicated intrahepatic and extrahepatic bile duct stones with portal stenosis:a clinical study of 16 cases

作　　者：刘昌军[1] 文浩权 阳利顺 沈贤波[1] 刘初平[1] 田秉璋[1] 毛先海[1] 尹新民[1] 彭创[1] 蒋波[1] 周海兰[1] 吴金术[1] LIU Chang-jun;WEN Hao-quan;YANG Li-shun(Department of hepatobiliary surgery,the First Affiliated Hospital of Hunan Normal University Hunan Provincial People's Hospital,Changsha 410005,China)

机构地区：[1]湖南师范大学第一附属医院湖南省人民医院,湖南长沙410005

出　　处：《中国实用外科杂志》2020年第10期1174-1176,1180,共4页Chinese Journal of Practical Surgery

基　　金：湖南省卫生计生委科研计划项目(No.20180443);湖南省教育厅优秀青年基金(No.18B045)。

摘　　要：目的探讨肝门腹侧肝脏切除手术处理复杂肝胆管结石并肝门狭窄的可行性和疗效。方法回顾性分析2015年1月至2019年8月湖南省人民医院肝胆外科采用肝门腹侧肝脏切除手术治疗的16例复杂肝内胆管结石并肝门狭窄病例的临床资料,随访观察结石清除及术后并发症情况。结果16例病人中4b段部分切除7例,5段部分切除3例,4b段+5段部分切除4例,部分4b段+5段切除2例。手术均顺利完成,无住院死亡,无严重并发症。术后随访时间6~57个月。所有病人疗效评估均为优。术后胆道造影检查均未见1、2级胆管狭窄,7例有3级胆管狭窄,发现少量结石残留,术后经胆道镜取净结石,5例未能取尽,密切随访观察,无明显临床症状。结论肝门腹侧肝脏切除手术可充分显露肝门胆管,更有效地处理复杂肝内外胆管结石并肝门狭窄,手术安全可行且能建立通畅的胆肠引流途径。ObjectiveTo explore the feasibility and outcome of resection of the ventral segment of the hepatic portal,for the treatment of complicated intrahepatic and extrahepatic bile duct stones with portal stenosis.MethodsToanalyze the cilinical data such as stone clearance rate,complications,and follow-up results of 16 cases,with complicatedintrahepatic and extrahepatic bile duct stones with portal stenosis who treated with resection of the ventral segment of thehepatic portal from January 2015 to August 2019 in Hunan Provincial People’s Hospital retrospectively.Results Among the 16 patients,7 cases received the resection of partial IVb segment of the liver;3 cases received the resection ofpartial V segment of the liver;4 cases received the resection of partial IVb and V segment of the liver;2 cases receivedthe resection of IVb and partial V segment of the liver.The operation was successful without death in hospital and seriouscomplications.The postoperative follow-up time was 6~57 months,and all of patients had an excellent evaluation oftherapeutic efficacy.There was no stenosis in primary and secondary bile ducts by postoperative cholangiography,but 7 cases exist stenosis in tertiary bile ducts with a few retained bile duct stone.5 cases were not completely removed afterpostoperative choledochofiberscopy.Close follow-up showed no obvious clinical symptoms.ConclusionThe resectionof the ventral segment of the hepatic portal is a safe and feasible method for the treatment of complicated intrahepatic andextrahepatic cholelithiasis with hilar stenosis,and it can fully expose the hilar bile duct.

关 键 词：复杂肝内胆管结石 胆管狭窄 肝门 肝蒂 切除 腹侧段 

分 类 号：R6[医药卫生—外科学]