肝胆管结石并左肝肥大右肝萎缩的处理

MANAGEMENT OF INTRAHEPATIC CHOLELITHIASIS WITH THE HYPERTROPHIC LEFT LOBE AND ATROPHIC RIGHT LOBE

目的 总结手术治疗肝胆管结石并左肝肥大、右肝萎缩的经验。方法 对 3 7例肝胆管结石并左肝肥大、右肝萎缩患者进行手术并随访 ,其中施行 T管引流 13例 ,肝肠盆式 Roux-Y吻合 2 0例 ,跳跃式肝肠 Roux-Y吻合 4例 ,同时附加左肝叶部分切除 3例 ,右肝叶部分切除 5例 ,脾脏切除 2例。结果 术后发现残余结石 8例 ,占 2 1.6% ,经术后胆道镜检查取石 ,取净 2例 ,最后残石率降致 16.2 %。无死亡病例。随访 3 7例 ,且均超过半年 ,在随访中出现不同程度的胆管炎 4例 ,效果优良者占 89.2 %。结论 术前影像检查和合并症的处理是手术成功的保证 ;肝胆管的充分显露和切开是手术成功的关键 ;术式选择要视梗阻部位、胆管狭窄和扩张的程度及术中患者的情况而定 ,以肝叶或段切除和保留

Objective To evaluate the treatment of intrahepatic bile stones accompany with left hepatic hypertrophy and right hepatic atrophy.Methods 37 cases of operation were followed up.13 cases underwent'T' tube drainage,20 cases underwent hepatobiliary duct'Basin'Roux-Y cholanyiojejunostomy,4 cases underwent jumps Roux-Y cholangiojejunostomy.While 3 cases of left hepatic part lobectomy,5 cases of right hepatic part lobectomy,2 cases of splenectomy.Results 8 cases with residual stone found after operation,the residual rate was 21.6%,the residual stone was eliminated in 2 cases undergoing fibrocholedochoscope treatment,the residual rate became 16.2%.No death occurred after operation,all were followed up and all had been followed up over half years.There were 4 cases attack cholongitis,the rate of good result achieved 89.2%.Conclusion Image examination in preoperation and management in preioperation were the guarantee for the operative success.Incision and appearance of intrahepatobiliary tracts were the key of operative success.Operative typeswere decided by the position of obstruction,bile duct stricture and expanding degree and situation of operation.Hepatic lobectomy or segmentectomy and maintaining oddi function had the best curative effect.