合并肝尾状叶胆管结石的诊治体会

Diagnosis and surgical treatment of complicated caudate hepatolithiasis

目的总结肝尾状叶胆管结石的诊断与外科治疗经验。方法回顾性地分析23例肝尾状叶胆管结石的病例资料。结果23例行肝胆B型超声,诊断肝尾状叶胆管结石1例;11例行经内镜逆行胰胆管造影(ERCP),诊断肝尾状叶胆管结石5例;17例行肝脏CT,诊断肝尾状叶胆管结石14例。19例行胆总管探查+胆道镜取石+T管引流术,术后肝尾状叶胆管结石残留11例;4例行胆总管探查+胆道镜检查+左半肝切除+肝尾状叶切除+T管引流术,术后无尾状叶结石残留。结论联合应用肝胆B型超声、ERCP和肝脏CT可以提高肝尾状叶胆管结石的术前诊断率;术中胆道镜检查及对尾状叶的触诊可进一步诊断肝尾状叶胆管结石;肝尾状叶切除术是彻底解决肝尾状叶胆管结石残留与复发的外科治疗方法。

Objective To summarize the experience in diagnosis and surgical treatment of caudate hepatolithiasis. Methods The clinical data were retrospectively analyzed in 23 patients with caudate hepatolithiasis,who were treated in our hospital. Results Twenty-three cases received B ultrasound of the liver and gallbladder, and one case was diagnosed as caudate hepatolithiasis; 11 cases received ERCP,and 5 cases were diagnosed as caudate hepatolithiasis; 17 eases received the liver CT,and 14 cases were diagnosed as caudate hepatolithiasis. Nineteen cases received common bile duct exploration＋ stone removal under choledochoscope ＋ T-tube drainage, 11 cases retained caudate hepatolithiasis after surgery;4 cases received common bile duct exploration ＋ choledochoscope ＋ left hepatectomy ＋ eaudate lobe resection＋ T-tube drainage,and they all were stone-free after surgery. Conclusion The combined application of B ultrasound of the liver and gallbladder, ERCP and liver CT can improve the preoperative diagnostic rate of caudate hepatolithiasis; intraoperative choledochoscope and palpation of caudate lobe of the liver can increase the diagnosis of caudate hepatolithiasis; eaudate lobe resection is a radical surgical treatment to solve the problem of residual stones and recurrence stones.