手术联合胆道镜治疗老年肝内外胆管结石96例  

Operation combined with cholangioscopy in the treatment of 96 cases of elderly patients with intrahepatic and extrahepatic bile duct stones

作　　者：过欣来[1] 郑亚新[1] 

机构地区：[1]同济大学附属东方医院普外科,上海市200120

出　　处：《老年医学与保健》2016年第3期-,共3页Geriatrics & Health Care

摘　　要：目的 探讨外科手术联合胆道镜治疗老年肝内外胆管结石的安全性和可靠性.方法 回顾分析2008年1月-2013年12月间年龄大于65岁的老年肝内外胆管结石96例.术前通过CT、MRI明确诊断,术前评估肝功能.手术方式:胆总管切开取石T管引流50例,肝叶切除+胆总管切开取石+T管引流42例,胆总管切开取石+胆肠吻合术+T管引流4例,附加胆囊切除术52例.术中胆道镜取石,并且T管引流,术后所有病例均行胆道镜检查并取石治疗,术后所有病人均口服利胆药物.手术时间:90～270 min,术中出血量:肝叶切除出血:300～1 200mL,输血23例(23/42)占54.8％,非肝叶切除出血:50～600mL,输血7例(7/54)占12.9％.结果 96例老年患者手术后痊愈出院,无手术死亡.术后2个月经T管胆道镜检查,结石残余54例,56.3％,胆道镜取石成功.平均2次胆道镜取净结石.术后发生胆漏16例,切口感染8例,术后严重肝功能损伤2例经内科保守治疗,肝功能恢复良好.结论 老年肝内外胆管结石患者选择合理的手术及引流方式,术后及时处理手术并发症,辅以胆道镜术中、术后检查取石,可有效治疗肝内外胆管结石.Objective To investigate the safety and efficacy of surgical operation combined with cholangioscopy in the treatment of elderly patients with intrahepatic and extrahepatic bile duct stones.Methods 96 patients aged over 65 years old admitted to hospitalization due to intrahepatic and extrahepatic bile duct stones from January 2008 to December 2013 were retrospectively analyzed.Preoperative diagnosis was made by CT and MRI.50 patients received choledocholithotomy with T-tube drainage,42 hepatolobectomy+ choledocholithotomy with T-tube drainage,4 choledocholithotomy with Ttube drainage+cholangiojejunostomy,and 52 additional cholecystectomy.After operation,all patients had oral choleretic drug.Results 96 cases were cured and discharged.After 2 months of operation,cholangioscopy exploration through the T tube was performed to remove the residual stones.The residual stones were removed with average 2 times of cholangioscopy examination.There were 16 cases of bile leakage,8 cases of incision infection,2 case with severe liver function injury was treated and recovered after conservative treatment in the internal medicine department.Conclusion Rational operation and drainage method are effective in the treatment of bile duct stones.

关 键 词：老年 肝内和外胆管结石 手术 胆道镜 

分 类 号：R657.42[医药卫生—外科学]