肝段联合切除治疗肝内胆管结石及狭窄  

Combined hepatic segmentectomy for treatment of hepatolithiasis with intrahepatic duct stricture

作　　者：李洪[1] 邢雪[1] 刘卫国[1] 胡义利[1] 王一[1] 

机构地区：[1]青岛市市立医院肝胆外科,山东省266011

出　　处：《中华肝胆外科杂志》2003年第12期743-744,共2页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨肝内胆管结石合并肝内胆管狭窄的手术治疗措施。方法 1994年1月至2002年1月共施行肝段切除治疗肝内胆管结石病人338例。Ⅱ、Ⅲ段联合切除284例,Ⅱ、Ⅲ、Ⅳ段联合切除8例,Ⅴ、Ⅵ段联合切除14例,Ⅵ、Ⅶ段联合切除9例,Ⅱ、Ⅲ、Ⅴ、Ⅵ段联合切除6例,Ⅱ、Ⅲ、Ⅵ、Ⅶ段联合切除5例,Ⅳb段切除12例。结果本组中3例手术后死亡。28例存在肝内胆管的残余结石,残余结石发生率为8.28％。手术结合纤维胆道镜取石,取净率为97.93％。结论联合肝段切除为治疗肝内胆管结石并狭窄的有效措施,手术结合术后纤维胆道镜取石能明显提高肝内胆管结石并狭窄的治愈率。Objective To explore the surgical modalities of hepatolithiasis with intrahepatic duct stricture. Method A total of 338 patients underwent hepatic segmentectomy from Jan. 1994 to Jan. 2002. of these patients, 284 cases underwent Ⅱ and Ⅲ hepatic segmentectomy, 8 did Ⅱ , ⅢandⅣ segmentectomy, 14 did Ⅴand Ⅵ segmentectomy,9 did Ⅵ andⅦsegmentectomy, 6 did Ⅲ, Ⅴand Ⅵ segmentectomy,5 did Ⅱ,Ⅲ,Ⅵ and Ⅶsegmentectomy and 12 did Ⅳb segmentectomy. Results Three patients died postoperatively. Twenty-eight cases had residual stone in intrahepatic duct and the incidence of residual stone was 8. 28%. The stone-clearing rate was 97. 93% through surgical modality combined with choledochoscopy treatment through T tube fistulas. Conclusion The combined hepatic segmentectomy was one of the most effective measures for treatment of hepatolithiasis with intrahepatic duct stricture. The surgical modality combined with choledochoscopy treatment could obviously increase the curative rate of hepatolithiasis with intrahepatic duct stricture.

关 键 词：肝段切除术 手术治疗 肝内胆管结石 合并症 肝内胆管狭窄 

分 类 号：R657.4[医药卫生—外科学]