中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (03): 208-210.

• 论著 • 上一篇    下一篇

肝右叶肝内胆管结石102例手术治疗体会

何    领，李文美   

  1. 徐州医学院附属医院普外科，江苏徐州221002
  • 出版日期:2010-03-01 发布日期:2010-03-12

  • Online:2010-03-01 Published:2010-03-12

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摘要：

目的     探讨肝右叶肝内胆管结石的手术治疗策略。方法    回顾性分析2000年1月至2008年12月徐州医学院附属医院收治的102例肝右叶肝内胆管结石的手术治疗方法及疗效。结果    规则性肝段切除术30例；其余72例行肝方叶切除，胆总管及一、二级胆管切开取石，其中20例行T管或U管引流，33例行胆管成形后T管或U管引流，19例行胆肠吻合术，合并胆总管结石42例（41.2%），术中均同时行胆总管切开取石。所有病例术后黄疸逐渐消退，肝功能好转，并发生胆漏6例（5.9%），结石残余5例（4.9%），并发胆管炎3例（2.9%），术后结石复发8例（7.8%）。结论    对于肝右叶肝内胆管结石采用规则肝段切除术或切除肝方叶，胆总管及一、二级胆管切开取石，行狭窄胆管成形，T管或U管引流或行胆肠吻合术可取得良好的治疗效果。狭窄胆管成形后，T管或U管引流术与胆肠吻合术相比，可降低术后并发症的发生率，并有利于并发症的处理。

关键词: 肝内胆管结石, 肝切除, 外科治疗

Abstract:

Surgical treatment of hepatolithiasis in right lobe of liver: a report of 102 cases        HE Ling，LI Wen-mei. Department of General Surgery，Affiliated Hospital of Xuzhou Medical College，Xuzhou 221002，China
Corresponding author：LI Wen-mei，E-mail：L5748036@126.com
Abstract    Objective  To explore the surgical treatment of hepatolithiasis in right lobe of liver. Methods    Retrospective analysis the surgical treatment methods and efficacy of the 102 cases of hepatolithiasis in right lobe of liver in affiliated  hospital of Xuzhou medical college from January 2000 to December 2008. Results    30 cases in this group  underwent hepatic segmentectomy; and the remaining 72 cases underwent resection of the liver lobi, and incided common bile duct，Ⅰ and Ⅱ grade bile duct and removed the stones，Of which 20 cases were placed directly T-tube or U-tube drainage，33 cases were formed the narrow bile ducts and placed T-tube or U-tube drainage，and 19 cases received choledochojejunostomy. 42 cases combined common bile duct stones which  underwent incision of common bile duct and removed the stones. All cases of postoperative jaundice subsided gradually, and liver function improved. Postoperative bile leakage occurred in 6 cases (5.9%), residual calculi happened in 5 cases(4.9%), cholangitis happened in 3 cases（2.9%）received cholecystojejunostomy，8 cases (7.8%) recurrent hepatolithiasis.  Conclusion    Hepatic segmentectomy or resection of the liver lobi ，incision of the secondary bile duct and removing the stones，forming the narrow bile duct，and placing T-tube or U-tube drainage or choledochojejunostomy for hepatolithiasis in right lobe of liver can obtain a good therapeutic effect. In addition，Forming bile duct stenosis, and placing T-tube or U-tube drainage can reduce the occurrence of postoperative complications, and more conducive to deal with complications.

Key words: hepatolithiasis, liver resection, surgical treatment