复杂肝胆管结石病治疗决策的思考:五例典型病例分析

The surgical management of complicated hepatolithiasis:a report of 5 cases

目的探讨复杂肝胆管结石的手术治疗原则。方法回顾性总结5例复杂肝胆管结石病人的临床资料,分析并探讨其诊疗过程。结果 5例病人中有1例为右前叶胆管和胆囊管异位汇合,1例为左肝内胆管结石伴右肝管可疑狭窄,1例为左肝内胆管结石合并癌变,1例为右后叶胆管结石,1例为右前叶胆管结石伴肝萎缩,分别从不同角度展示了复杂肝胆管结石的特点。5例病人分别通过合理的手术治疗均痊愈,且预后良好,随访无结石残留或复发,无死亡等严重并发症。结论复杂肝胆管结石的诊治决策过程中,应当始终坚持和活学活用"取尽结石,去除病灶,解除梗阻,通畅引流"的治疗原则。

Objective To discuss the surgical principles for complicated hepatolithiasis. Methods We retrospectively reviewed 5 cases of complicated hepatolithiasis and explored the optimal surgical strategies for them. Results Five patients presented with different characteristics of complicated hepa- tolithiasis. One patient had right anterior segmental hepatic duct emptying directly into the cystic duct. One patient had left-sided hepatolithiasis with suspected right hepatic duct stricture. One patient had left-sided hepatolithiasis complicated by intrahepatic carcinoma. One patient had stones involved the right posterior segmental hepatic duct, and 1 patient had stones involved the right anterior segmen- tal hepatic duct combined with liver atrophy. All patients were successfully treated by surgeries. The postoperative course was uneventful for these patients, and all cases had favorable outcome during the follow-up period. Conclusions During the treatment of complicated hepatolithiasis, we should adhere to the surgical principles of ＂clear stones, eradicate lesions, relieve obstruction, and restore drain- are＂.