肝胆管结石术后并发症的防治(附180例分析)

Prevention and treatment of postoperative complications of hepatolithiasis: an analysis of 180 cases

目的探讨肝胆管结石手术后并发症及其影响因素,合理选择肝胆管结石的术式,预防或减少肝胆管结石的术后并发症。方法对180例肝胆管结石手术术后并发症进行回顾性分析。结果本组肝胆管结石术后1～30d内79例(439%)发生术后并发症,发生率较高的术后并发症有残余结石(217%)、切口感染(111%)、胸水(100%);在不同的术式中,单纯T管外引流术后并发症率为500%,胆肠内引流术为469%,肝叶段切除+T管外引流术为310%,肝叶段切除+胆肠内引流术为600%,肝叶段切除术后并发症率较低且易于处理;全组手术死亡率17%。结论肝胆管结石手术并发症多,发生率高,结石部位和手术术式是影响术后并发症的主要因素,肝区段切除术既能达到治愈肝胆管结石及由其引起的肝胆病理改变的目的,又能获得较低的术后并发症率;对常见的术后并发症提出预防措施,探讨手术技巧的改进。

Objective To investigate the postoperative complications of hepatolithiasis and their correlative factors to select rational types of operation and prevent or reduce the complications. Methods The clinical data of 180 patients with hepatolithiasis surgically treated in our hospital were retrospectively analyzed. Results A total of 19 types of complications occurred in 79 (43.9%) patients within 30 days after the operation. The first three complications of high occurring rate were residual stone (21.7%), wound infection (11.1%) and pleural effusion (10.0%). As for operative approaches, the occurring rate of postoperative complications was 50.0% for T-tube insertion, 46.9% for cholangioenterostomy, 31.0% for hepatic resection + T-tube insertion and 60.0% for hepatic resection + cholangioenterostomy. Hepatic resection had the lowest occurring rate of postoperative complications that were easy to manage. The hospital mortality was 1.7% for all the 180 patients. Conclusions The occurring rate of postoperative complications is high for hepatolithiasis. The stone location and operative approaches are 2 important influencing factors for occurrence of postoperative complications. Hepatic resection is a good choice because it can not only deal with hepatolithiasis and associated pathological changes but also result in low occurring rate of postoperative complications. Meanwhile, some suggestions are posed for prevention and reduction of common complications and improvement of operative skills.