Ⅵ段肝管解剖结构与肝内胆管结石外科处理

Anatomy of segment Ⅵ hepatic duct and surgical management of hepatolithiasis

目的 探讨Ⅵ段肝管解剖结构与肝内胆管残余结石、复发结石的关系及外科治疗方案。方法 术中观察 75例肝内胆管结石并胆管扩张者Ⅵ段肝管开口部位及肝管走向 ;回顾性分析 33例右肝残石的结石分布。结果 Ⅵ段肝管汇入夹角多小于 90°、行程迂曲 ;右肝内胆管孤立结石多见于Ⅵ段肝管。结论 Ⅵ段肝管行程迂曲及汇入夹角小是肝内残石及复发结石的重要原因。解除胆管开口狭窄、矫治胆管畸形及肝段切除是预防结石复发的关键措施。

Objective To probe into the relationship between anatomy of segment Ⅵ hepatic duct and residual or recurrent hepatolithiasis and its surgical management. Methods Intraoperative observation of the opening locations of segment Ⅵ hepatic duct was made in 75 consecutive cases with hepatolithiasis combined with cholangiectasis. Retrospective analysis of distribution of hepatolithiasis was made in 33 cases with residual stones in the right liver. Results Most of the convergence angles of segment Ⅵ hepatic duct were smaller than 90° with a tortuous route. And most of the isolated hepatolithiasis located in segment Ⅵ hepatic duct in the right liver. Conclusions Tortuous traveling route and small convergence angles of segment Ⅵ hepatic duct are important causes of residual or recurrent hepatolithiasis. The key to prevent recurrent hepatolithiasis is release of strictured openings of biliary tracts and resection of the damaged liver segments.