合并尾状叶结石的肝内胆管结石20例临床分析

Clinical analysis of 20 cases of intrahepatic bile duct stones combined with caudate bile duct stones

目的 探讨合并尾状叶结石的肝内胆管结石的合适的诊治方法.方法 20例合并尾状叶结石的肝内胆管结石,采用肝尾状叶切除联合左外叶切除10例,采用左外叶切除联合尾状叶胆管切开取石T管引流5例,肝右叶切除联合尾状叶切除1例.肝左叶切除联合尾状叶胆管切开取石T管引流2例,肝右后叶切除联合尾状叶切除2例.结果 并发胸腔积液12例,切口感染1例,胆漏2例,死亡1例.随访2年,2例联合尾状叶胆管切开取石T管引流患者仍有胆管结石复发,间断出现胆道感染症状.结论 联合尾状叶切除术可以达到良好的远期效果,是合并尾状叶结石的肝内胆管结石的较好的治疗方法.

ObjeCtive investigate met^hods To the suitable of diagnosis and treatment of intrahe- patic bile duct calculus combined with caudate bile duct stones. Methods The clinical data of 20 cases of intrahepatic bile duct stones combined caudate bile duct stones were analyzed,including 10 cases of can- date and left external lobectomy,5 cases of left external lobectomy combined with caudate bile duct lithoto- my and T tube drainage, 1 case of caudate and right lobectomy,2 cases of left and caudate lobectomy and T tube drainage, and 2 cases of right posterior and caudate lobe resection. Results There were pleural effu- sion in 12 cases,wound infection in 1 case,fistula in 2 cases and death in 1 case. During the follow-up pe- riod of 2 years, 2 patients with combined caudate lobe lithotomy and T tube drainage still had bile duct stone recurrence and discontinuous biliary tract infection symptoms. Conclusion Combined candate lo- bectomy can achieve good long-term effect, which is the best treatment of intrahepatic bile duct stones com- bined with candate bile duct stones.