规则性肝切除联合胆肠吻合术治疗复发性化脓性胆管炎的疗效分析

Effectiveness and experience of regular hepatectomy combined with hepaticojejunostomy for recurrent pyogenic cholangitis

目的探讨规则性肝切除联合胆肠吻合术治疗复发性化脓性胆管炎的疗效及手术操作体会。方法回顾性分析香港大学深圳医院肝胆胰外科2015年7月至2017年7月采用规则性肝切除联合胆肠吻合术治疗复发性化脓性胆管炎共43例病例资料。结果本组病例全部顺利完成手术,平均手术时间为(396±159.5)min,平均术中出血量为(650±1275)ml,术中彩超和胆道镜联合探查有2例结石残留,术中完全结石清除率为95.3%。平均术后住院时间为(16±4)d,术后发生手术相关并发症(伤口感染、胆漏、腹腔感染、术后肠梗阻等)共12例(27.9%),其中10例保守治疗、2例行二次手术治疗,最终全部病例痊愈出院。术后无肝衰竭病例,术后90天无死亡病例。43例均获得随访,随访时间为6~30月。所有患者中,仅2例出现胆道感染,无结石复发。结论规则性肝切除联合胆肠吻合治疗复发性化脓性胆管炎,能够彻底去除结石和病灶,降低复发率,是治愈复发性化脓性胆管炎安全、有效的方法,且疗效满意。

Objective To investigate the effectiveness and experience of regular hepatectomy combined with hepaticojejunostomy for recurrent pyogenic cholangitis. Methods The data of 43 cases of recurrent pyogenic cholangitis undergoing regular hepatectomy combined with hepaticojejunostomy in our center from Jul. 2015 to Jul. 2017 were analyzed retrospectively. Results All patients underwent regular hepatectomy combined with hepaticojejunostomy. The average operative time was （ 396 ± 159. 5 ） min, and the average of intraoperative blood loss was （650 ± 1275） ml. Two patients with residual stones through the checking of intraoperative B-ultrasound and cholangioscopy. Complete stone clearance rate was 95.3%. The postoperative hospital stay was （ 16 ± 4） days. Twelve postoperative complications （ wound infection, bile leakage, abdominal infection and intestinal obstruction） developed in 43 patients （27.9%）, 10 of the 12 case were cured by conservative treatment, the other 2 case uderwent second operation. No liver failure occurred. No death within 90 days after the operation. All patients were followed-up for 6 to 30 months. Biliary infection occurred once in the 2 cases, none of the cases had stone recurrence. Conclusions Regular hepatectomy combined with hepaticojejunostomy for recurrent pyogenic cholangitis could completely remove stones and lesions, and reduce the rate of stone recurrence. It is safe and feasible, with favorable efficacy.