肝部分切除术治疗肝内胆管结石术后复发的的临床分析

Discussing the Recurrence after Segment Liver Resection for Hepaolithiasis

目的:探讨肝部分切除治疗肝内胆管结石术后复发的原因与对策。方法:回顾分析近五年间因肝内胆管结石而行肝部分切除术后复发再次手术的16例病人,按原结石所在肝叶/段、类型、手术方式、发病时间和复发时间,分析其临床疗效,复发原因。这些患者术后未进行定期复诊,未进行系统的利胆排石治疗。结果:近五年因肝内胆管结石肝部分切除术后复发再次手术病例,男6例、女10例,年龄37～69岁,结石类型均为胆红素结石;病变部位,右肝后叶4例,左肝叶9例,全肝均累及3例,发病时间4～5年,术后病理均发现胆管炎症。结论:肝部分切除术是目前公认的治疗肝内胆管结石的最有效的方法,该法能彻底清除肝内病变胆管,但缺乏直观、简便的定位诊断(如术中B超),遗漏病灶是影响远期疗效及复发的主要原因,术后无服用利胆排石药物,没有按医嘱改变饮食习惯也是结石复发的影响因素。外科治疗复发肝内胆管结石仍然以肝叶切除加(或)胆肠吻合为首选。

Objective: To discuss the causes of recurrence after segment liver resection to treat with hepatolithiasis. Methods: According to the calculus type,location,operation way,attacking time and recurrent time,the reoperation cases for recurrence after segment liver resection have been reviewed,they didn’t come back to check again periodically,and post-operative therapy weren’t done. Results: There are 16 cases, the ages alter 37～69 years old, all of them are bilirubinate gallstone,which locate in right-posthepatic lobe (4 cases)and left hepatic lobe (9 cases),3 cases were found to attack bellyworm,the recurrence times are 4～5 years. the pathologiology demonstrate the lesion bile duct expanded as a vesica and chronic inflammation,the hyperplasia with little vascular of matris and fibro tissues. Conclusions:Segment liver resection is now commonly acknowledged to cure hepatolithiasis as it can relieve the bile duct obstruction,resect the contrictive hepatobiliary duct,improve the long-process effects.but the long –process effect are affected by the following:the long process、attacking repeatly、 not a single one place(lobe)of the liver have constrictive bile duct,without the most reliable diagnosis during operation,besides these,excluding the bellyworm,having chlorotic and lithagogne drugs,have not been changing the diet habit are the affected factors of recurrence too.