摘要
目的
探讨肝切除术治疗肝内胆管结石的合理术式及其疗效。
方法
本小组于2004年2月～2008年2月共收治肝内胆管结石并以肝切除术治疗的患者41人,根据结石分布及术中具体情况分别施行不同肝段(叶)切除术及引流,并结合术中、术后胆道镜检查。
结果
病例随访2～6年,术后疗效优32例(78.0%),良5例(12.2%),差4例(9.8%),术后最终残余结石3例(7.3%),复发3例,复发率7.3%,因残石或复发再手术4例,再手术率为9.8%。术后并发膈下脓肿1例,切口感染1例,皮下脂肪液化1例,T管脱出胆瘘1例,均经非手术治疗痊愈。未发生手术死亡。
结论
肝段(叶)切除联合合理的T管引流术或胆肠吻合引流术治疗肝内胆管结石效果良好,术中胆道镜的应用能降低手术残石率,合理的术式选择和规范的医疗操作能提高疗效、减少并发症、降低复发率和再手术率,术后胆道镜应用在胆道残石处理中起着重要作用。
Objective
To investigate the hepatic resection of intrahepatic bile duct stones and the efficacy of a reasonable surgical.
Methods
From February 2004 to February 2008 our group treated 41 patients of hepatolithiasis with liver resection. According to the distribution of stones and intraoperative specific purposes they were treated differently in the liver segment (lobe) resection and ways of drainage, combined with intraoperative and postoperative cholangioscopy.
Results
These patients were followed up 2 to 6 years after operation. Excellent result in 32 cases (78.0%), good in 5 cases (12.2%) and poor in 4 cases (9.8%). Postoperative residual stones in the final three cases (7.3%). The recurrence rate was 7.3%, and re-operation rate 9.8%, due to residual or recurrent stones in 4 cases, The incidence of complications after operation was 9.8%, including subphrenic abscess in 1 case, wound infection in 1 case, subcutaneous fat liquefaction in 1 case and T tube extrusion biliary with fistula in 1 case, who were all cured by non-surgical treatment. No operative mortality occurred.
Conclusion
hepatic segment (lobe) resection combined with rational T-tube drainage, or biliary-enteric anastomosis drainage in the treatment of hepatolithiasis works well. The application of intraoperative cholangioscopy can reduce the residual stone rate of surgery. Reasonable surgical options and norms of medical operation can improve efficacy, reduce complications and lower recurrence rate and re-surgery rate. Cholangioscopy plays an important role in treatment of postoperative residual bile duct stones.
引文
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