摘要
目的探讨治疗肝内胆管结石的手术方法及其临床效果。方法全组65例。中央型结石17例,周围型结石12例,局限型结石26例,弥漫型10例;合并肝胆管狭窄40例(61.5%),共施行肝叶(段)切除术27例,肝门胆管切开取石+高位胆管空肠Roux-en-Y吻合术17例,肝叶(段)切除+胆管空肠Roux-en-Y吻合术21例。结果术后有60例获得6个月～5年随访,优32例,良21例,差7例,优良率88.3%,术后残余结石12例(18.5%),经术后胆道镜结合液电碎石治愈10例,再次手术2例,胆漏3例,伤口感染5例,膈下脓肿2例,均经非手术治疗痊愈。未发生手术死亡。结论肝叶(段)切除联合胆肠吻合引流术或T管引流术治疗肝内胆管结石能提高疗效、降低残石率、减少并发症,术后胆道镜取石是治疗胆道残石的重要手段。
[Objective] To explore the operative methods and curative effect of surgical treatment for hepatolithiasis. [Methods] Of 65 patients with hepatolithiasis, 17 cases of central types,12 peripheral types, 26 local types and 10 suffusion existed respectively.Hepatolithiasis complicating with stenosis of bile duct existed in 40 cases （61.5%）. Hepatolobectomy（hepatic segmentectomy） was performed in 27 cases. Hepaticolithotomy combined with Roux-en-Y hepatocholangiojejunostomy was performed in 17 cases and hepatolobectomy（hepatic segmentectomy） combined with Roux-en-Y cholangiojejunostomy in 21. [Results] Postoperative follow up was carried out for from 6 months to 5 years in 60 cases： excellent in 32 cases, good in 21 and fair in 7. The excellent and good rate was 88.3%. Postoperative residual stones occurred in 12 cases （18.5%）. 10 cases with debris were cured by electrohydraulic lithotripsy （EHL）with choledochoscopy and 2 received reoperation. Bile leak occurred in 3 cases,incision infection 5, and subphrenic abscess 2. All the complications were cured by non-operative treatment.No perioperative mortality existed. [ Conclusion ] Hepatolobectomy combined with Roux-en-Y cholangiojejunostomy or T tube drainage is capable of improving clinical outcome, reducing the incidence rate of postoperative debris and complications in the treatment of hepatolithiasis. Postoperative choledochoscopy is an important approach for removing debris in biliary tract.
出处
《中国医学工程》
2007年第6期517-519,共3页
China Medical Engineering
关键词
肝内胆管结石
肝切除术
胆道残石
胆道镜
hepatolithiasis
hepatectomy
debris in biliary tract
choledochoscope
