摘要
目的 探讨肝内局灶性化脓性胆管炎与肝内胆管结石的关系和诊断与治疗。方法 回顾性总结 1991～ 1997年收治的肝内胆管结石并局灶性化脓性胆管炎 2 4例的诊断、治疗经验。结果 在行肝内胆管切开取石术 44例中 ,发现本病 2 4例。肝内局灶性化脓性胆管炎的梗阻部位为左肝管 5例 ,左外支肝管 7例 ,左内支肝管 8例 ,右肝管 1例 ,右后支肝管 2例 ,右前支肝管 1例。行胆肠盆式吻合术 19例 ,胆总管T管引流术 5例 ,其中合并肝叶切除 4例 ,经肝取石置管引流 7例。本组 2 4例均痊愈出院。结论 肝内局灶性化脓性胆管炎只有在胆道镜取石或手术切开Ⅰ～Ⅲ级肝管时方可确诊。治疗的主要措施为手术 ,即清除肝内胆管的嵌顿结石 ,解除狭窄 ,通畅引流 ,或病灶肝切除。
Objective[WT5”BZ] To evaluate the relations between diagnosis and treatment of hepatolithiasis accompanied by local suppurative cholangitis. [WT5”HZ]Methods [WT5”BZ] Summarization of experiences of diagnosis and treatment for 24 cases with hepatolithiasis accompanied by local suppurative cholangitis from 1991～1997 was made.[WT5”HZ] Result [WT5”BZ] 24 patients with hepatolithiasis accompanied by local suppurative cholangitis out of a total 44 patients treated with hepatolithectomy were found, which include 5 cases with left hepatico obstructive form, 7 cases with left external hepatico branch obstructive form, 8 cases with left internal hepatico branch obstructive form, 1 case with right hepatico obstructive form, 2 cases with right posterior hepatico branch obstructive form and 1 case with right anterior hepatico branch obstructive form. Hepaticojejunostomy was performed in 19, cholangiotomy plus T tube drainage in 5 patients,respectively, with concomitant hepatic segmentomy performed in 4 and concomitant hepatolithectomy plus drainage in 7.All patients recovered uneventfully and were discharged. [WT5”HZ] Conclusion [WT5”BZ] Diagnosis of hepatolithiasis accompanied by local suppurative cholangitis depends on choledochoscopy and surgical incision on Ⅰ Ⅲ degree hepatoducts. Surgery is the mainstay for the treatment of this disease including hepatic lobectomy, which removes the incarcerated bilestones in hepato biliary tracts so as to keep the biliary tract unobstructed. [WT5”HZ]
出处
《中华普通外科杂志》
CSCD
2000年第3期168-169,共2页
Chinese Journal of General Surgery
