经肝圆韧带肝膈面径路施行肝内胆肠吻合术治疗肝胆管结石21例临床观察

INTRAHEPATIC CHOLEDOCHOJEJUNOSTOMY THROUGH ROUND LIGAMENT APPROACH (REPORT OF 21 CASES)

报告采用经肝圆韧带肝膈面径路施行肝内胆管空肠吻合治疗肝胆管结石２１例，其中伴医源性胆管损伤５例，左肝管结石８例（伴狭窄７例），肝内泥沙状结石并急性化脓性胆管炎２例，胆总管Ｔ管引流术后左肝管残余结石伴囊状扩张３例，胆管外伤、多次胆管手术后及左肝管结石并出血各１例。患者年龄３２～５０岁占７５．９％。２１例经临床观察，效果尚属满意。作者认为，该手术具有操作具有简便易行，术野暴露满意；创伤性小、保存肝组织、勿须切肝；术后能迅速降压减黄等优点。另外，对手术适应证、吻合方法及操作细节、术中注意事项等问题进行了讨论。

Twenty one cases of hepatocholelithiasis treated through hepatic round ligament approach for hepaticojejunostomy is reported. Of them 5 were introgenic injury to the biliary tract, 8 were left hepatolithiasis (7 complicated with bile duct stricture), 2 were intrahepatic sandy stone with acute suppurative cholangitis, and 3 were residual stone in left hepatic duct with cyst like dilatation after T tube drainage; while traunatic injury to the biliary passages, previous multiple biliary tract operations and left hepatic duct stone with acute hemorrhage were present in one of case individually 75.9% each. The ages of the patients were between 32 to 50 years. Clinical follw up in this series was satisfactory. The authors consider that this approach gives good exposure with little injury to the liver and no liver resection needed. The indication for this approach mode of anastomosis and some operative details are discussed.