肝圆韧带修复肝门部胆管狭窄治疗肝胆管结石

Reconstruction of stenotic hilar bile duct with ligamentum teres hepatis in the treatment of intrahepatic bile duct stones

目的探讨利用肝圆韧带修复肝门部胆管狭窄治疗肝胆管结石的临床价值。方法选择50例肝胆管结石患者按随机数字表法随机分为两组:观察组25例利用肝圆韧带修复肝门部胆管狭窄;对照组25例采取局部肝段或肝叶切除。统计分析两组患者术中出血量、手术时间、术后胆漏及残石率、术后肝功能恢复情况。结果观察组患者术中出血量、手术时间明显少于对照组(P<0.05),术后肝功能受损程度及恢复时间明显优于对照组(P<0.05),术后胆漏及残石率差异无统计学意义(P>0.05),治疗效果良好。结论利用肝圆韧带修复肝门部胆管狭窄治疗未合并肝脏病理性改变的肝胆管结石,术中出血量少,手术时间短,取材方便,操作简便,符合胆道生理,效果良好,值得临床推广应用。

Objective To evaluate the efficacy of reconstruction of stenose hilar bile duct with pedicled ligamentum teres hepatis in the treatment of intrahepatic bile duct stones. Methods Fifty patients with intrahepatic bile duct stones were randomly divided into two groups. The control group（ n = 25） received hepatectomy,and the observation group（ n = 25） received bile duct reconstruction with pedicled ligamentum teres. The liver function,per-operative bleeding,time of operation,the incidence of postoperative bile leakage and residual stones in the two groups were calculated and analyzed. Results Peri-operative bleeding and time of operation in the observation group were less than those in the control group（P〈0. 05）. The degree and time of postoperative hepatic function recovery in the observation group were better than those in the control group（P〈0. 05）. There was no significant difference in the incidence of postoperative bile leakage and residual stones between the two groups（P〈0. 05）. Conclusion For patients with slenose hilar bile duct caused by intrahepatic bile duct stones,bile duct reconstruction with the ligamentum teres hepatis is effective and safe,with less bleeding and shorter time of operation.