肝段叶切除为主的联合手术治疗肝内胆管结石

Combined surgical treatment of hepatolithiasis mainly with liver lobectomy or segmentectomy

目的观察以肝段叶切除为主的联合手术治疗肝内胆管结石的效果。方法选择肝内胆管结石14例,根据其结石分布、胆管狭窄及肝硬化等临床病理表现,采取肝段叶切除联合肝断面胆管取石及(或)胆总管切开取石、各式胆肠RouX-en-Y吻合等方法,同时配合术后综合措施治疗。结果14例全部治愈,无死亡病例。术后出现腹壁切口感染1例、右肝内胆管结石残留1例,无胆漏、膈下感染、肝功能衰竭和上消化道出血等并发症。术后平均住院时间15d。术后随访12例,随访时间6个月～5年,症状完全消失8例(66.67%),偶有轻微腹痛、无需特殊治疗3例(25.0%),仍有发热、腹痛症状需入院治疗1例(8.33%)。效果优良者占91.67%。结论该手术切除了病变肝脏、狭窄胆管和清除了结石,同时联合胆总管切开取石引流、肝胆管或胆总管空肠吻合术是治疗肝内胆管结石的有效手段。

Objective To observe the effects of liver lobectomy or segmentectomy as the main technique in the treatment of calculus of intrahepatic biliary duct.Methods According to the distribution of stones,14 patients with hepatolithiasis were treated by liver lobectomy or segmentectomy,and/or combined with antegrade stone extraction or choledocholithotomy or cholangiojejunostomy.Results Surgeries of all 14 cases were successful and recovered.No death occurred,but 2 cases had postoperative complications:1 wound infection and 1 residual stone.The mean postoperative hospitalization was 15 days.12 cases were followed up from 6 months to 5 years,showing that 66.67%(8/12)were symptom-free,and 25.0%(3/12)had occasional mild attacks of cholangitis,and 8.33%(1/12)had severe cholangitis requiring further surgical intervention.Conclusion Liver lobectomy or segmentectomy with antegrade stone extraction or choledocholithotomy or cholangiojejunostomy is an efficient approach to cure calculus of intrahepatic duct as it can remove the contrictive hepatobiliary duct,and relieve the biliary duct obstruction.