摘要
目的探讨肝胆管结石的外科治疗选择。方法回顾性分析我院2009年3月至2013年10月外科手术治疗肝胆管结石136例。既往有胆道手术史的61例,有2次手术史的8例,3次以上的3例。术前根据影像检查结果,结合中华医学会胆道外科学组制订的《肝胆管结石病诊断治疗指南》将每个病例分成1个主型。其中Ⅰ型94例,Ⅱ型42例,Ⅱ型中Ⅱc型13例。术中再根据胆道镜判断Oddi括约肌功能状态,确定附加型,其中Ea型109例,Eb型26例,Ec型1例。结果手术方式:联合肝部分切除76例,单纯胆管切开取石55例,胆肠内引流术11例。2例Ⅱc型伴有严重的胆汁性肝硬化和门静脉高压症,先行脾切除,待肝功能改善后,术后再择期行胆管切开取石,恢复良好。6例术后病理证实癌变,其中4例为胆管细胞癌,1例为肝肉瘤,另1例为肝细胞性肝癌。55例术后胆道残余结石,其中34例术后经一次胆道镜将结石取尽,余经2次以上胆道镜取石。本组无手术死亡病例,术后切口感染15例,胆汁漏3例,均经引流治愈。结论应重视肝胆管结石的首次手术治疗,避免再次手术。对Ⅱc型患者可采取先行脾切除,再胆管切开取石的分期手术,可明显改善患者的生存质量。
Objective To investigate surgical treatment options for hepatolithiasis. Methods 136 patients who were operated with hepatolithiasis were retrospectively analyzed from March 2009 to October 2013. 61 patients were subject to previous operations including, twice operations in 8 patients, and three time operations in 3 patients. Based on the results of imaging and the classification of Guideline for the diagnosis and treatment of hepatolithiasis, all patients were classified 1 prime type. Type I was 94 patients, and type Ⅱ was 42 patients. 13 patients was type Ⅱ c in type Ⅱ. Then, additive type was determined by the choledochoscope observing the Oddi sphincter. Type Ea was 109 patients, type Eb was 26 patients, and type Ec was 1 patient. Rusults Modus operandi： hepatectomy were 76 patients, choledocholithotomy were 55 patients, choledochojejunosfomy were 11 patients. 2 patients of type Ⅱ c with grave bili- ary cirrhosis and portal hypertension were operated by stages： First, the spleen was ablated, second choledocholithotomy was executed after 3 month, when the liver function was improved. 6 patients were proved to be malignant by pathology ： Cholangiocellular carcinoma were 4 patients, hepatic sarcoma was 1 patient, and hepatocellular liver cancer was 1 patient. 55 patients with postoperative residual stone ： the stone were dislodge one time by choledochoscope in 34 patients, and the rest with twice or more. No operative mortality was observed. Postoperative complications included wound infection （15 patients） and bile leakage （3 patients）, all of the patients were cured by drainage. Conclusions To avoid reoperation, the first operation of hepatolithiasis is important. Type Ⅱ c can be operated by stages ： first, the spleen was ablated, then choledocholithotomy was executed, the quality of life can be improved.
出处
《肝胆外科杂志》
2014年第4期257-259,共3页
Journal of Hepatobiliary Surgery
关键词
肝胆管结石
外科治疗
hepatolithiasis
surgical treatment
