肝叶(段)切除治疗肝内胆管结石并狭窄的体会

Treatment of calculi in intrahepatic bile duct with strictured tract by liver lobectomy

目的探讨肝内胆管结石并/或胆管狭窄行肝叶(段)切除治疗的疗效。方法对53例肝内胆管结石并/和胆管狭窄行肝叶(段)切除及胆管整形胆囊带蒂肝胆管修补术,其中左半肝切除3例,左肝外叶切除38例,左肝外叶下段切除7例,右肝前叶下段切除3例,右肝后叶不规则切除2例,同时行胆管整形6例,胆囊带蒂肝胆管修补2例。结果除术后切口感染5例、残余结石7例、胰漏2例、左侧胸腔积液1例、右侧胸腔积液1例外,其余37例均无异常;全组无1例手术死亡。结论对肝内胆管结石并狭窄的患者,在术前经B超、CT、逆行胰胆管造影(ERCP)等检查充分了解肝内胆管结石分布、胆管狭窄情况后,拟定周密治疗方案,可确保手术成功,并取得满意疗效。

Objective This paper try to explore the effective treatment of patients with calculi in intrahepatic bile duct with strictured tract by means of liver lobectomy. Methods 53 patients with intrahepatic bile duct calculi complicated with strictured duct were treated by liver lobectomy, tract reshaping and gallbladder attachment repair, Among them, half liver resection of left part was carried out in 3 cases, front left liver resection in 38 cases, removal of left - lower part of liver in 7 cases, lower right part liver resection in 3 cases, irregular resection of posterior lobe in 2 cases, biliary tract reshaping in 6 cases and gallbladder attachment repair in 2 cases. Results Infection of post - operative incision was occurred in 5 cases, incomplete biliary calculus removal in 7 cases, pancreatic leakage in 2 cases, left pleural effusion in 1 case, right pleural effusion in 1 case and no abnormal condition occurred in the remaining 37 cases. No death occurred in this series of patients. Conclusion With a well - made therapeutic plan, successful operation and effective treatment can be achieved if such patients are checked thoroughly with ultrasound B, CT scanning, ERCP etc for the distribution of billary calculi and the stricture of bile duct .