区域型肝胆管结石病的“一站式”处理:附74例报告

发布时间：2019-03-16 14:09

【摘要】：目的:探讨"一站式"外科治疗区域型肝胆管结石病的可行性。方法:回顾性分析2013年1月—2016年8月收治的74例区域型肝胆管结石病患者的临床资料。患者均行"一站式"外科治疗,即以规则性肝切除为基础,依靠术中B超和胆道镜的指引,一次性去清结石、切除病变胆管及病损性肝脏。结果:74例患者中,术前影像学判断结石分布符合率达94.6%(70/74)。74例均行规则性肝切除,左半肝切除21例,左外叶切除8例,右半肝切除17例,右后叶切除16例,右前叶切除4例,右后叶+左外叶切除5例,扩大右半肝切除3例;行解剖性肝切除49例(66.2%);7例曾行胆肠内引流患者中5例因吻合口狭窄加行吻合口重建;71例行T管引流术,另外3例患者因重建胆肠吻合口后预留肝总管短未放置T管;平均手术时间(235.7±35.6)min,平均出血量(415.3±106.8)m L。无死亡病例,11例出现并发症经保守治疗好转;术后平均住院时间为(9.2±4.1)d。6例术后胆道T管造影可疑结石,门诊再行胆道镜检查或取石。所有患者获随访3~24个月,2例曾行胆肠内引流吻合口未重建者期间出现过1次胆道感染,保守治疗好转;21例胆总管结石复发予以ERCP+EST处理。结论:严格的术前评估,选择合适的病例,"一站式"外科治疗区域型肝胆管结石病安全可行,且疗效满意。
[Abstract]:Objective: to investigate the feasibility of one-stop surgical treatment of regional hepatolithiasis. Methods: the clinical data of 74 patients with regional hepatolithiasis from January 2013 to August 2016 were retrospectively analyzed. All patients underwent "one-stop" surgical treatment, that is, on the basis of regular hepatectomy, depending on the guidance of B-ultrasound and choledochoscope, one-off removal of stones, removal of the diseased bile duct and the damaged liver. Results: the coincidence rate of preoperative imaging diagnosis was 94.6% (70 / 74). All 74 patients underwent regular hepatectomy, left half hepatectomy in 21 cases, left lateral lobectomy in 8 cases, right hemi hepatectomy in 17 cases, right posterior lobectomy in 16 cases, and regular hepatectomy in 21 cases, left lateral lobectomy in 8 cases, right half hepatectomy in 17 cases and right posterior lobe resection in 16 cases. There were 4 cases of right anterior lobectomy, 5 cases of left lateral lobectomy of right posterior lobe and 3 cases of extended right hemi-hepatectomy. Surgical hepatectomy was performed in 49 cases (66.2%), 5 of 7 patients who had undergone biliary and intestinal drainage underwent anastomotic reconstruction due to stricture of anastomotic orifice. 71 cases were treated with T-tube drainage, the other 3 cases had no T-tube reserved after reconstruction of choledochojejunostomy, the average operation time was (235.7 卤35.6) min, the average bleeding volume was (415.3 卤106.8) m L.). There were no death cases, 11 cases had complications improved by conservative treatment, the average postoperative hospitalization time was (9.2 卤4.1) d.6 cases were suspected of choledocholithiasis by T-tube cholangiography after operation, and choledochoscopy or lithotomy were performed in the out-patient department. All the patients were followed up for 3 months for 24 months. Two patients who had not undergone reconstruction of choledochal drainage anastomoses had one biliary tract infection during which conservative treatment improved, and 21 patients with choledocholithiasis recurrence were treated with ERCP EST. Conclusion: the "one-stop" surgical treatment of regional hepatolithiasis is safe and feasible, and the curative effect is satisfactory.
【作者单位】：安徽医科大学附属省立医院胆胰外科/肝胆胰外科安徽省重点实验室;
【基金】：安徽省高等学校省级自然科学研究基金资助项目(KJ2013Z143)
【分类号】：R657.42

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