肝内胆管结石伴肝门部血管变异的手术处理

Surgical treatment of intrahepatic biliary calculi with blood vessel variation in hepatic hilus

目的 探讨肝内胆管结石伴肝门部血管变异的手术处理方法。 方法 回顾性分析 5 7例肝内胆管结石伴肝门部血管变异行胆道手术病人的临床资料。结果 5 7例中 ,行单纯胆道手术 13例 ,异位血管切断、结扎术 14例 ,胆管血管交叉换位术 2 2例 ,肝内胆管空肠吻合术 8例。本组未发生严重术后并发症和围手术期死亡。 5 1例 ( 89.6 % )获得随访 ,随访时间 4～ 15 (平均 9.6 )年。疗效优良率84.3% ( 4 3/5 1)。 7例有胆道残余结石 ,其中 5例表现为间歇性右上腹隐痛不适 ,另 2例因反复发作的胆管炎需再次手术。 1例术后 1.5年死于门静脉高压症所致的食道胃底曲张静脉破裂大出血。 结论 采用合适的手术方式治疗肝内胆管结石伴肝门部血管变异 ,既能完成复杂胆道手术 。

Objective To evaluate the procedure of surgical treatment of intrahepatic biliary calculi with blood vessel variation in hepatic hilus. Method The clinical data of 57 patients with intrahepatic biliary calculi and blood vessel variation in hepatic hilus treated by biliary operation were retrospectively analyzed.Results The simply biliary operation was performed on 13 cases ; variant blood vessels were cut off and ligated in 14 cases;The bile duct and blood vessel across conversion operation were performed on 22 cases;and the intrahepatic cholangiojejunostomy was carried out in 8 cases. There were no severe postoperative complications and perioperative mortality.51 patients(89.6%) were followed up for 4 to 15 years with the exellent results in 43(84.3%)cases. There were residual stones in 7 cases,of them,5 patients had intermittent abdominal pain in the right upper quadrant; reoperation was performed on another 2 cases because of recurrent cholangitis. One died of variceal bleeding 1.5 years after operation. Conclusions In order to accomplish the complex operations of biliary tract and avoid ischemic damage of liver, proper operation should be chosen for patients with intrahepatic biliary calculi with blood vessel variation in hepatic hilus.