复杂型肝内胆管结石外科治疗的临床研究

发布时间：2018-05-29 14:40

本文选题：肝内胆管结石 + 胆道探查术　；参考：《东南大学学报(医学版)》2017年04期

【摘要】：目的:探讨复杂型肝内胆管结石外科治疗的术式选择及疗效评价。方法:对107例复杂型肝内胆管结石患者行胆道探查、胆道镜联合激光碎石,其中行胆道探查+T管引流术77例,规则性肝叶切除术16例,胆总管空肠吻合术9例,肝4b段切除+肝门部胆管整形空肠盆式吻合术5例;术后经T管窦道胆道镜取石、激光碎石、球囊扩张62例。结果:首次手术结石取净率为38.32%,肝叶切除术组(75.00%)优于胆道探查术组(27.27%);残余结石患者二期经窦道取石62例,取净结石53例,取净率为85.48%。107例患者取净结石94例,取净率为87.85%。围手术期胆总管空肠吻合术组和肝门胆管空肠盆式吻合术组严重并发症发生率高;远期疗效优良率胆总管探查术组为94.37%,肝叶切除术组为93.75%。结论:胆道探查取石术是治疗肝内胆管结石的首选术式,肝叶切除术适用于局部肝实质萎缩,胆肠吻合术适用于胆管口括约肌功能障碍患者。术后经窦道胆道镜取石是解决肝内胆管残余结石的重要手段,疗效显著。对复杂型肝内胆管结石治疗应提倡个体化、精准化及器官保护。
[Abstract]:Objective: to evaluate the surgical treatment of complicated intrahepatic cholelithiasis. Methods: 107 patients with complicated intrahepatic cholelithiasis underwent biliary tract exploration, choledochoscope combined with laser lithotripsy. Among them, 77 patients underwent choledochoscopy T-tube drainage, 16 patients underwent regular hepatectomy, and 9 patients underwent choledochojejunostomy. Liver 4b segment resection of hepatic hilar bile duct plastic jejunojejunostomy in 5 cases, postoperative T-tube sinus choledochoscopy, laser lithotripsy, balloon dilatation in 62 cases. Results: the removal rate of stones in the first operation was 38.32 and 75.00 in the hepatectomy group was better than that in the exploratory choledochectomy group, 62 patients with residual stones were removed through the sinus tract, 53 patients had the stones removed, and the net rate was 85.48.107 patients. Perioperative choledochojejunostomy group and hilar cholangiojejunostomy group had high incidence of severe complications, and the long term curative effect of choledochojejunostomy group was 94.37 and hepatic lobectomy group was 93.75. Conclusion: choledocholithiasis is the first choice in the treatment of intrahepatic cholelithiasis. Lobectomy is suitable for local atrophy of hepatic parenchyma and cholangiojejunostomy for patients with sphincter dysfunction. Postoperative choledochoscopy is an important method to solve residual stones of intrahepatic bile duct. Individualization, precision and organ protection should be advocated in the treatment of complicated intrahepatic cholelithiasis.
【作者单位】：贵州医科大学附属医院肝胆外科;贵州省德江县中医院普外科;贵州医科大学附属肿瘤医院肝胆外科;
【基金】：贵州医科大学附属医院博士科研启动基金项目(20140430)
【分类号】：R657.42

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