左肝胆管结石诊治体会

Diagnosis and treatment experiences of the left hepatolithiasis

目的探讨左肝胆管结石的诊断与治疗方式。方法对我院2004年5月～2012年5月120例左肝胆管结石患者的诊断和治疗资料进行回顾性分析。结果行左肝外叶切除50例,左半肝切除52例,胆道探查取石+胆肠内引流12例,胆道探查+T管引流6例,全组无手术死亡病例,术后并发症发生率为9.1%,包括切口脂肪液化4例、胆瘘5例、腹内出血1例、肠瘘1例,均经保守治疗痊愈,无膈下脓肿、胆道出血等并发症。术后残石率为8.3%(10/120)。结论左肝胆管结石的诊断应从四个方面进行诊断:结石部位、狭窄、变异及并发症;左肝内胆管结石的处理应遵循个体化方案,选择适当的手术方法,提高手术技巧,对降低残石率、减少并发症发生率十分重要。

Objective To summarize the experience on diagnosis and treatment of the left hepatolithiasis.Methods Data of 120 patients hospitalized for hepatolithiasis from May 2004 to May 2012 were collected and analyzed retro spectively.Results There were 50 patients used for hepatic left lateral lobectomy,50 patients used for left liver resection,12 patients used for bile duct exploration＋Biliary enteric drainage and 6 patients used for bile duct exploration＋ T-tube drainage,there was no mortality in operation.The incidence of complications after operation was 9.1%,including wound infection（4 cases）,bile fistula（5 cases） and abdominal hemorrhage（1 case）.Subphrenic abscess,bile tract bleeding and anastomotic leaks did not happen among these cases.the rate of residual stones after operation was 8.3%（10/120）.Conclusion The diagnosis of the left hepatolithiasis from four aspect ：the position of stone,stenosis,variation and complication.The treatment of hepatolithiasis should be individualized,selecting appropriate operative ap proach and improving operative technology would be important for descending the rate of residual stones and complications.