摘要
目的:评价多肝段联合切除治疗复杂肝胆管结石的效果。方法:回顾性分析93例肝胆管结石患者行多肝段联合切除术的临床资料。术式包括行右半肝切除5例,右后叶切除7例,右后叶切除加肝左外叶切除2例,肝Ⅷ段加尾状叶切除1例,肝Ⅷ段加左外叶切除3例,肝Ⅶ,Ⅷ段次全切除加左外叶切除术2例,右前叶切除5例,肝Ⅳ,Ⅴ段切除2例,肝Ⅳ,Ⅴ,Ⅷ段次全切除5例,左半肝切除19例,左半肝加尾状叶切除4例,肝Ⅳ段切除6例,左外叶切除32例。附加手术包括胆肠吻合术22例;所有患者行胆囊切除,胆道镜检查和/或取石,术后胆总管T管引流。结果:全组无手术死亡病例。发生并发症17例(18.2%),其中胆瘘2例(2.2%),膈下感染1例(1.1%),切口感染6例(6.4%),肺部感染3例(3.2%),胸腔积液6例(6.4%),应激性溃疡2例(2.2%),均经治疗痊愈出院。术后发现残石9例,经胆道镜取净结石5例。全组随访89例(95.7%)。3例合并胆管癌的患者死于胆管癌复发,3例胆管结石复发。结论:以多肝段联合切除为主的手术方式是治疗肝胆管结石的有效手段。
Objective： To evaluate the efficacy of multiple hepatic segmentectomies for complex hepatolithiasis. Methods： The clinical data of 93 patients with hepatolithiasis who underwent multiple liver segmentectomies were retrospectively analyzed. The procedures included 5 cases of right lobectomy, 7 cases of right posteriorlobectom）5 2 cases of right posterior lobe plus left lateral lobe resection, 1 case of segment Ⅷ plus caudate lobectomy, 3 cases of segment Ⅷ and left lateral lobe resection, 2 case of subtotal segment Ⅶ and Ⅷ plus left lateral lobe resection, 5 cases of right anterior lobectomy, 2 cases of segment Ⅳ and Ⅴ resection, 5 cases ofsegment Ⅳ, Ⅴ and Ⅷ resection, 19 cases of left lobectomy, 4 cases of left and caudate lobectomy, 6 cases of segment Ⅳ resection, and 32 cases of left lateral lobectomy. Additional choledochojejunostomy was performed in 22 cases. All the patients underwent cholecystectomy, cholangioscopic exploration and/or stone extraction, and common bile duct T-tube drainage.
Results： There was no operative mortality. Postoperative complications occurred in 17 cases （18.2%）,including 2 cases of bile leakage （2.2%）, 1 case of subphrenic infection （1.1%）, 6 cases of wound infection （6.4%）, 3 cases of pulmonary infection （3.2%）, 6 cases of pleural effusion （6.4%）, and 2 cases of stress ulcer （2.2%）. All of these complications resolved before the patients were discharged. In 9 cases, residual stoneswere found after operation and they were completely removed by cholangioscopy in S of them. Follow-up was obtained in 89 cases （95.7% of the whole group）, of whom 3 cases with concomitant cholangiocarcinoma died of tumor recurrence and 3 cases developed bile duct stone recurrence.
Conclusion： Multi-segmentectomies as the main operation modality is effective in the treatment of complex hepatolithiasis.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2012年第2期127-131,共5页
China Journal of General Surgery
关键词
胆结石/外科学
肝切除术/方法
胆管
肝内
Cholelithiasis/surg
Hepatectomy/methods
Bile Ducts, Intrahepatic
