超声辅助下病变胆管区肝切除治疗区域性肝胆管结石

发布时间：2018-11-29 13:21

【摘要】：目的:探讨术中超声辅助下病变胆管区肝切除治疗区域性肝胆管结石的临床疗效。方法:对2012年10月—2015年6月间,将超声辅助下病变胆管区肝切除的27例区域性肝胆管结石患者的临床资料进行回顾性分析。结果:27例患者中,男16例,女11例;平均年龄(46.4±8.3)岁。7例有胆道手术史。结石分布于S4(2例),S5(8例),S6(10例),S8(4例),S5+S8(3例)。所有患者均采用超声辅助下的病变胆管区的肝切除。平均术中出血量为(336.3±94.3)m L,平均手术时间为(235.9±37.8)min,平均住院时间为(12.5±2.4)d。5例出现术后并发症,包括胆汁漏2例,切口感染3例。经残端胆管行胆道探查16例中发生并发症2例;行胆总管切开探查者11例中发生并发症3例,两者并发症发生率无统计学差异(P0.05)。24例患者获得随访,随访时间3~36个月,1例发生肝外胆管结石,经EST治愈,其余患者无结石复发及临床症状。结论:对于区域性肝胆管结石患者,可采用超声辅助下的病变胆管区肝切除,术中胆道探查应首选经肝断面残端胆管进行。
[Abstract]:Objective: to evaluate the effect of intraoperative ultrasound-assisted hepatectomy on regional hepatolithiasis. Methods: the clinical data of 27 patients with regional hepatolithiasis were retrospectively analyzed from October 2012 to June 2015. Results: of the 27 patients, 16 were male and 11 were female, with an average age of (46.4 卤8.3) years. Stones were found in S4 (2 cases), S5 (8 cases), S6 (10 cases), S8 (4 cases) and S5 S8 (3 cases). All patients were treated with ultrasound-assisted hepatectomy of the diseased bile duct area. The average intraoperative bleeding volume was (336.3 卤94.3) m L, the mean operation time was (235.9 卤37.8) min, the average hospitalization time was (12.5 卤2.4) days, including bile leakage in 2 cases, incision infection in 3 cases. Complications occurred in 2 out of 16 patients who underwent biliary exploration via stump bile duct. Complications occurred in 3 out of 11 patients who underwent choledocholithotomy (P0.05). 24 patients were followed up for 3 ~ 36 months. One patient developed extrahepatic cholelithiasis and was cured by EST. The other patients had no recurrence and clinical symptoms. Conclusion: for the patients with regional hepatolithiasis, ultrasonic assisted hepatectomy of the diseased bile duct should be adopted. The exploration of biliary tract should be carried out first through the remnant bile duct of the liver section during the operation.
【作者单位】：成都军区总医院全军普通外科中心;
【基金】：四川省青年科技创新研究团队资助项目(2011JTD0010)
【分类号】：R657.42

【相似文献】