肝内胆管结石再手术治疗分析

Reoperation for Intrahepatic Lithiasis

目的探讨不同手术方式治疗肝内胆管结石的再手术疗效。方法60例肝内胆管结石患者,按再手术方式分为2组:A组47例,行肝叶(段)切除;B组13例,行非肝叶(段)切除。评估其手术措施及效果。结果A组肝段(叶)切除术中同时行胆管空肠吻合25例,肝断面扩张胆管、肝门胆管与空肠双口吻合10例,T管和U管引流分别为8例和4例。B组均行非肝叶(或肝段)切除术,包括经圆韧带入路取石纠正狭窄5例,经肝表面切开与肝门胆管探查联合手术4例,单纯肝外胆管探查取石、胆肠吻合4例。术后并发症:A组3例,B组5例,两组比较有显著差异(P<0.05)。两组均获随访,时间2～7年,术后结石残留率A、B组分别为4.26%与23.08%,症状复发分别为0和23.08%,两组比较有统计学差异(P<0.05)。结论肝叶(或肝段)切除的各种术式是再手术治疗肝内胆管结石较为有效的手段。

Objective To investigate the therapeutic effect of reoperation for intrahepatic lithiasis. Methods 60 cases of intrahepatic lithiasis were divided into two groups based upon the procedures, group A has 47 cases that underwent hepatectomy, and group B has 13 cases without liver resection. Result In group A, bilioenteric reconstruction were done in single anastomosis in 25 cases, double anastomosis in 10 cases, the T and U tube for drainage were applied in 8 cases and 4 cases respectively. In group B, the removal of stones were done via the approach of round ligament in 5 cases, liver surface in combination with bile duct in 4 cases and extrahepatic bile duct along with bilioenteric anastomosis in 4 cases. No death occurred in both groups. The complication rate were of no significant difference in both group, while the rate of residual stone and recurrent symptom were significantly higher in group B than group A. Conclusion Hepatectomy is an effective ap- proach to retreat the intrahepatic lithiasis.