规则性肝段(叶)切除治疗肝内胆管结石并狭窄

Regular Hepatic Segmentectomy or Lobectomy for Hepatolithiasis Combined with Bile Duct Stricture

目的探讨规则性肝段(叶)切除治疗肝内胆管结石并狭窄的临床疗效。方法48例肝胆管结石并狭窄患者,行左外叶切除19例,左半肝切除2例,左外叶+右后叶(或单纯Ⅵ、Ⅶ段)切除7例,右半肝(或单纯Ⅵ、Ⅶ段)切除20例;均行胆总管探查、T管引流术;行胆管空肠Roux-en-Y吻合术13例。结果术后胆管残石5例(10.4%),切口感染3例(6.2%),胆漏2例(4.2%)。随访41例(85.4%),2例肝内胆管结石复发,1例右上腹隐痛,其余随访结果优良。结论根据患者结石及狭窄的具体情况采用以肝段切除为主的手术方式是治疗肝内胆管结石并狭窄的有效手段。

Objective To study the clinical effects of regular hepatic segmentectomy or lobectomy for hepatolithiasis combined with bile duct stricture. Methods The clinical data of 48 patients suffered from hepatolithiasis combined with bile duct stricture were retrospectively analyzed. In all the patients, exploration of the common bile duct and T-tube drainage were used after hepatic segmentectomy or lobectomy. And 13 cases underwent Roux-en-Y cholangiojejunostomy. Results There were 5 cases （ 10.4% ） of remnant stone, 3 cases（6.2% ） of incisional infection and 2 cases （4.2%） of bile leakage after operation. 41 cases were followed up in whom 2 cases recured calculus, 1 case still complained of bellyache in the fight upper abdomen. Conclusion Hepatic segmentectomy is an effective method to treat hepatolithiasis combined with bile duct stricture in according to different specific conditions.