中国实用外科杂志

中国实用外科杂志

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非肝切除外科治疗86例Ⅲa型肝胆管结石病疗效分析

潘    孟，李敏朋，俞    渊，潘    壮，朱继业   

  1. 广西中医药大学第一附属医院肝胆外科，广西南宁 530023
  • 出版日期:2019-04-01 发布日期:2019-04-04

  • Online:2019-04-01 Published:2019-04-04

摘要：

目的    探讨Ⅲa型肝胆管结石病治疗策略。方法    回顾性分析2014年7月至2017年12月广西中医药大学第一附属医院肝胆外科收治的86例Ⅲa型肝胆管结石病病例的临床资料，均采用非肝切除的外科治疗。观察结石残留情况、术后胆道镜取石次数、结石清除率、复发率及疗效等指标。结果    共23例胆管狭窄病人，其中3例为肝门部胆管狭窄，行肝门部胆管修补成型；20例为肝内胆管开口狭窄，行胆道镜球囊扩张。首次治疗残留结石83例（96.5%）。术后6周左右经T管窦道或皮下盲袢窦道行胆道镜取石，取石3（1~10）次；4例病人残留小部分结石，结石清除率为95.4%。2例发生胆漏，通畅引流后治愈。随访时间24（3～36）个月，80例（93.0%）治疗效果为优；6例（7.0%）术后结石复发，6例（7.0%）偶发胆管炎。结论    通过胆道手术及联合胆道镜纠正狭窄、取除结石治疗Ⅲa型肝胆管结石病安全可行，近期治疗效果满意。

关键词: 肝胆管结石病, 胆道探查, 胆道镜, 胆漏

Abstract:

Analysis of treatments for 86 cases type Ⅲa hepatolithiasis without hepatectomy        PAN Meng，LI Min-peng，YU Yuan，et al. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi University of Chinese Medicine，Nanning 530023，China
Corresponding author：PAN Meng，E-mail：panmengdr@163.com
Abstract    Objective    To explore therapeutic strategies of type Ⅲa hepatolithiasis. Methods    The clinical data of 86 patients with type Ⅲa hepatolithiasis admitted from July 2014 to December 2017 in Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi University of Chinese Medicine were retrospectively analyzed. Patients without liver resection were included. Variables including residual stones，times of choledochoscopy performing，stone clearance rate and recurrence rate were observed. Results    There was a total of 23 patients with biliary strictures and 2 cases of bile leakage after operation，83 patients (96.5%) residual stones after Initial treatment. About six weeks after surgery，the choledochoscopy was performed via T tube sinus or subcutaneous blind loop. The median lithotomy times was 3. There were 4 cases of residual small stones，and stone clearance rate was 95.4%. Median follow-up time was 24 months. 6 patients (7.0%) had recurrent intrahepatic bile duct stones，and the proficiency was 93.0% (80/86). 6 patients (7.0%) had sporadic cholangitis. Conclusion    It is safe and feasible to correct the stricture and remove the stones through the combination of biliary surgery and choledochoscope for type Ⅲa hepatolithiasis. The short-term outcomes are satisfactory.

Key words: hepatolithiasis, bile duct exploration, choledochoscope, bile leakage