肝内胆管结石肝部分切除术后复发的探讨

Discussing the recurrence after segment liver resection for hepaolithiasis

目的 :探讨肝内胆管结石肝部分切除术后复发的原因。方法 :回顾分析近五年间因肝部分切除术后复发再次手术的肝内胆管结石病例 ,按原结石类型、所在肝叶 /段、手术方式、发病时间和复发时间 ,分析其临床疗效 ,复发原因。结果 :近五年因肝内胆管结石肝部分切除术后复发再次手术病例 10例 ,男 4例、女 6例 ,年龄 34～ 6 8岁 ,结石类型均为胆红素结石 ;病变部位 ,右肝后叶 2例 ,左肝叶5例 ,全肝均累及 3例 ,发现蛔虫 6例 ,病理检查均提示病变胆管囊状扩张及慢性炎 ,间质小血管及纤维组织增生。发病时间 4～ 5年 ,复发时间分别为 2、4、5、6年 ;患者均来自低收入家庭 ,术后均无进行定期随诊 ,无进行驱蛔治疗及系统的利胆排石治疗。结论 :肝胆管结石病行肝部分切除术 ,是目前公认的能有效提高肝内胆管结石的远期治疗效果的外科治疗手段 ,能达到解除肝管梗阻 ,切除狭窄肝胆管和去除化脓性感染病灶的目的 ;但病程长 ,胆管炎反复发作 ,全肝多处肝叶或肝段胆管存在狭窄 ,且缺乏最高的定位诊断 (如术中B超 ) ,令病灶难以彻底切除是影响远期疗效的主要原因 ;此外 ,术后无进行驱蛔虫治疗 ,服用利胆排石药物 ,改变饮食习惯是结石复发的影响因素。

Objective: To discuss the causes of recurrence after segment liver resection to treat with hepatolithiasis.Methods: According to the calculus type,location,operation way,attacking time and recurrent time,the reoperation cases for recurrence after segment liver resection have been reviewed. Results:There are 4 cases,men and women are half,the ages alter 33～44 years old, all of them are bilirubinate gallstone,which locate in right-posthepatic lobe (2case)and left hepatic lobe (5 cases),3 cases were found to attack bellyworm,the attacking time last 4～5 years,the recurrence times are 2?4?5?6 years.the patients' incomes are low,they didn't come back to check again periodically,and post-opertative therapy weren't done. the pathologiology demonstrate the lesion bile duct expanded as a vesica and chronic inflammation,the hyperplasia with little vascular of matris and fibro tissues. Conclusions:Segment liver resection is now commonly acknowledged to cure hepatolithiasis as it can relieve the bile duct obstruction,resect the contrictive hepatobiliary duct,improve the long-process effects.but the long -process effect are affected by the following:the long process?attacking repeatly? not a single one place(lobe)of the liver have constrictive bile duct,without the most reliable diagnosis during operation,besides these,excluding the bellyworm,having chlorotic and lithagogne drugs,have not been changing the diet rabit are the affected factors of recurrence.