胆道结石合并肝硬化的临床分析与手术治疗

Clinical analysis and surgical treatment of biliary calculi with cirrhosis

目的探讨胆道结石合并肝硬化的临床特征和手术时机及方式。方法选择胆道结石合并肝硬化29例,分别施行单纯胆道手术24例,一期行胆道手术加脾切除门奇断流术4例,胆道手术加肝叶切除术1例。并对其术前检查情况、有效改善肝功能状况、纠正凝血机制障碍、采用灵活手术方案、术后治疗及其并发症情况等进行探讨。结果术后加强保肝、支持治疗,均顺利渡过麻醉及手术期,术后出现低蛋白血症及腹水4例,胆漏2例,左膈下积液1例,切口感染1例,肝内胆管结石残留3例,均经保守治疗恢复。无死亡病例。结论加强围手术期处理、尽量避免急诊手术、选择合适的手术方式治疗肝硬化胆道结石患者仍可获得良好效果。

Objective To study the clinical features and the operative time and methods of biliary calculi with cirrhosis.Methods 29 cases of biliary calculi with cirrhosis treated by surgery were analyzed.There were 24 cases with biliary operation,and 4 cases with splenectomy plus porta-agygous devascularization and biliary operation performed in one-stage procedure,and one case with biliary operation and formal left lateral hepatectomy.Results All the patients had passed through the process of anesthesia and surgical operation by protection of hepatic function and supporting treatment before operation.Postoperative complications occurred in 4 cases of hypoalbuminemia with ascites,2 postoperative bile leakage,1 left subdiaphragmatic effusion,1 wound infection,and 3 remained intra-hepatic cholelithinsis.All of these patients recovered after appropriate treatments.Conclusions If optimization of perioperative treatment,avoiding of emergent operation and suitable surgical procedures,favorable efficacy might be achieved in patients with biliary calculosis with cirrhosis.