围肝门外科技术治疗复杂肝内胆管结石

Perihilar surgical techniques for complicated intrahepatic cholangiolithiasis

目的探讨围肝门外科技术在治疗复杂肝内胆管结石中的可行性。方法分析2021年6月至11月南京医科大学附属淮安第一医院收治的6例复杂肝内胆管结石患者的临床资料,有3例患者既往因肝内胆管结石结石,在当地医院行肝左外叶切除联合胆肠内引流手术。6例患者入院时均存在肝内胆管结石,伴肝门部胆管狭窄或原胆肠吻合口狭窄。4例患者术前有间隙性黄疸。结果6例患者均采用围肝门外科技术完成手术。其中围肝门联合肝右后叶切除术1例;围肝门联合左半肝切除术1例;围肝门联合残余左半肝切除,胆肠吻合口重建术3例;围肝门联合经肝正中裂劈开取石术1例。手术时间为110~215 min,平均150 min;出血量130~470 ml,平均220 ml。采用加速康复理念对患者进行围手术期管理。术后无胆漏、无出血、无肝功能不全、无腹水等并发症。术后住院时间为10~15 d,平均12 d。结论围肝门外科技术可以用于复杂肝内胆管结石的治疗。

Objective To explore the feasibility of perihilar surgical techniques in the treatment of complicated intrahepatic cholangiolithiasis.Methods The clinical data of 6 patients with complicated intrahepatic cholangiolithiasis were retrospectively analyzed,who admitted to the Affiliated Huaian No.1 People s Hospital of Nanjing Medical University from June to November 2021.Three patients underwent left lateral hepatic lobectomy combined with biliary-intestinal drainage in local hospital due to intrahepatic cholangiolithiasis.There were six patients admitted to hospital with intrahepatic cholangiolithiasis and hilar bile duct stenosis or postoperative anastomotic stenosis and four patients with intermittent jaundice before operation.Results The procedures were completed by perihilar surgical techniques in all 6 patients,including 1 case operated combined with right-posterior lobe hepatectomy,1 case treated combined with left hemi hepatectomy,3 cases operated combined with resection of residual left hepatic lobe and bilio-enteric anastomosis for biliary reconstruction and 1 case operated combined with lithotomy via median hepatic fissure.The operation time was 110-215 min,with an average of 150 min.The average volume of intraoperative blood loss was 220 ml(130-470 ml).The patients were given enhanced recovery after surgery in the perioperative period of surgery.No postoperative complications occurred,such as biliary leakage,bleeding,liver insufficiency and ascites.Postoperative hospital stay ranged from 10 to 15 days,with an average of 12 days.Conclusion Perihilar surgical techniques can be used in the treatment of complicated intrahepatic cholangiolithiasis and is worth to popularize.