术中超声引导肝切除治疗复杂性肝内胆管结石

The value of intra-operative ultrasound in the hepatectomy treatment for complicated intrahepatic bile duct stone

目的评价术中超声引导下肝切除治疗复杂性肝内胆管结石的临床价值。方法运用术中超声于手术过程中对89例复杂性肝内胆管结石的患者行结石定位,引导器械取石,指导确定手术切除范围及术式选择。结果术中引导行器械取石及行肝叶和肝段切除术,其中切除肝左外叶46例,左半肝11例,右半肝8例,肝Ⅴ、Ⅵ段9例,肝后叶3例,肝左外叶加肝Ⅴ、Ⅵ段7例,肝左外叶加尾状叶5例,未发生术中误损伤、大出血等情况,术后行术中超声及T型管造影示6例结石残留,残留率约6.74%。结论术中超声引导下肝切除治疗复杂性肝内胆管结石术有利于术者确定手术切除范围及术式选择以达到最佳手术效果。

Objective To probe the value of intra - operative ultrasound （IOUS） in the hepatectomy treatment for complicated intrahepatic bile duct stone. Methods Eighty - nine cases with comphcated intrahepatic bile duct stone underwent high frequency ultrasound during the surgical procedure. Results The all 89 patients underwent regular or irregular hepatectomy under the guidance of IOUS without severe damage and hemordaage. Among them, 46 cases with left external lobe hepatectomy, 11 cases with left lobe hepatectomy, 8 cases with right lobe hepatectomy, 9 cases with Ⅴ and Ⅵ segment hepatectomy, 3 cases with caudate lobe hepatectomy. Six cases were found stone remains after surgery by IOUS and T - Tube imaging and the rate of residual stones after the operation was 6. 74 %. Conclusion IOUS in the hepatectomy treatment for comphcated intrahepatic bile duct stone is good for the choice of surgical type and hepatectomy region.