单纯切除病变胆管分支治疗右肝区域性胆管结石的疗效分析

Clinical efficacy of simple resection of affected bile ducts for rightsided regional hepatolithiasis

目的：探讨单纯切除病变胆管分支治疗右肝区域性胆管结石的临床疗效。方法：回顾性分析2008年11月—2014年11月19例右肝区域性胆管结石行单纯病变胆管分支切除的患者资料。结果：19例患者中,男8例,女11例;9例有胆道手术史;结石均局限于V、VI或VII段的3级及以上胆管。患者手术方式均为单纯病变胆管分支切除,即根据术前影像学资料和术中B超检查,确定病变胆管根部位置及结石范围,切除包括病变胆管及其周围受损的肝组织,不行常规胆囊切除和胆管引流。手术出血量100-500 mL,手术时间2-4.5 h,肝门阻断时间10-20 min。术后胆瘘3例,胸水1例,膈下脓肿1例,结石残留1例;住院期间无死亡病例。17例患者获得随访3-72个月,其中2例患者行CT、MRI检查可疑结石复发,其他患者无临床症状且检查无结石复发,生活质量优良率88.2%。结论：对于肝胆管结石仅局限于V、VI或VII段的3级及以上胆管的患者,可采取单纯切除病变胆管分支的手术方式,且具有较好的疗效。

Objective： To investigate the clinical efficacy of simple resection of the affected bile ducts for right-sided regional hepatolithiasis. Methods： The clinical data of 19 patients with right-sided regional hepatolithiasis undergoing simple resection of the affected bile ducts from November 2008 to November 2014 were retrospectively analyzed. Results： Of the 19 patients, 8 cases were males and 11 cases were females; 9 cases had a history ofbiliary surger）5 and stones in all cases were locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII. All patients underwent simple resection of the affected bile ducts, namely, excision of the affected bile ducts along with the surroundings impaired hepatic tissues after determination of the location of the root of the affected bile ducts and range of the stones according to preoperative imaging data and intraoperative ultrasound examination, without routine cholecystectomy and biliary drainage. The intraoperative blood loss was 100-500 mL, operative time was 2-4.5 h, and time of total hepatic inflow occlusion was 10-20 min. Bile leakage occurred in three cases, and pleural effusion, subphrenic abscess and residual stones were found in one case each after operation; no death occurred during hospitalization. Seventeen patients were followed up for 3-72 months, two patients had suspicious stone recurrence found by CT and MRI examination, but no clinical symptoms or stone recurrence was noted in the remaining patientsj and the rate of excellent quality of life was 88.2%. Conclusion： Simple resection of the affected bile ducts may have a good effect in patients with stones locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII.