中国实用外科杂志

中国实用外科杂志

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肝胆管结石合并肝内感染灶的外科治疗（附62例报告）

曹庭加，李汉军，胡逸林，汪    波，傅    涛，卢绮萍   

  1. 广州军区武汉总医院普通外科，湖北 武汉430070
  • 出版日期:2016-03-01 发布日期:2016-03-01

  • Online:2016-03-01 Published:2016-03-01

摘要：

目的    探讨肝胆管结石合并肝内感染灶的治疗方法。方法    回顾性分析2010年1月至2015 年12 月间，广州军区武汉总医院采用经皮经肝胆管引流（PTCD）、肝叶切除术治疗肝内胆管结石及肝内感染灶的62例病人的临床资料。结石及感染灶分布于双侧肝内胆管者12例（19.4%），局限分布于左外叶10例（16.1%），左半肝23例（37.1%），右前叶1例（1.6%），右后叶8例（12.9%）及右半肝8例（12.9%）。对脓肿直径>3 cm，在超声引导下经皮肝脓肿穿刺抽脓或穿刺置PTCD管引流。病情稳定，全身情况改善后行确定性手术，包括肝胆管结石病灶及脓肿切除或引流。结果    术后并发症发生率：切口感染9例（17.3%）、粘连性肠梗阻4例（6.5%）、胆漏2例（3.2%）、胆道出血1例（1.6%）、肝断面及膈下感染1例（1.6%）、严重腹腔感染1例（1.6%），无肝功能衰竭。术后因为严重腹腔感染致全身多器官功能衰竭死亡1例（1.6%）。随访6个月至5年，随访率80.7%（50/62）。5年内疗效优良者占88.7%（55/62），8.1%（5/62）病例因未行规则性肝切除，遗留病变的胆管，结石再发、胆道反复感染而需进一步手术处理。结论    遵循个体化原则，充分引流感染灶，同时或择期进行肝胆管结石并感染病灶切除是治疗肝胆管结石合并感染的最佳方案。

关键词:  , 胆石症, 肝胆管结石, 肝脓肿, 肝切除

Abstract:

Surgical treatment of liver abscess caused by cholelithiasis：A report of 62 patients        CAO Ting-jia，LI Han-jun，HU Yi-lin，et al. Department of General Surgery，Wuhan General Hospital of Guangzhou Military Command of PLA，Wuhan 430070，China
Corresponding author：LU Qi-ping, E-mail: 13871160000@163.com
Abstract    Objective    To investigate the therapeutic method of liver abscess caused by cholelithiasis. Methods    The clinical data of 62 patients with liver abscess caused by cholelithiasis undergoing hepatectomy and/or percutaneous transhepatic cholangiography and drainage (PTCD) in Department of General Surgery，Wuhan General Hospital of Guangzhou Military Command of PLA from January 2010 to December 2015 were analyzed retrospectively. Stones and foci of 12 patients (19.4%) distributed in the bilateral intrahepatic bile duct，10 patients (16.1%) in the left lateral lobe of liver，23 patients (37.1%) in left lobe of liver，1 patient (1.6%) in right anterior lobe of liver，8 patients (12.9%) in right posterior lobe of liver and 8 patients (12.9%) in right lobe of liver. When the abscess diameter > 3cm，percutaneous abscess pus aspiration or puncture PTCD drainage implant were perfomred and guided by ultrasound. Patients with stable disease，general condition improved underwent definitive surgery，including hepatectomy and abscess drainage. Results    Postoperative complication rate：wound infection in 9 patients (17.3%)，intestinal obstruction in 4 patients (6.5%)，bile leakage in 2 patients (3.2%)，biliary tract bleeding in 1 patient (1.6%)，liver section / subphrenic infection in 1 patient (1.6%)，severe abdominal infection in 1 patient (1.6%)，with no liver failure. One patient (1.6%) died in perioperative  peroid because of multiple organ failure caused by severe abdominal infection. Fifty patients (80.7%) were followed up for 6 months to 5 years. The efficacy was good in 55 patients (88.7%) and poor in 5 patients (8.1%)，and the 5 patients need further surgical treatment for the infection because of the stone recurrence，recurrent biliary infection. Conclusion    Following the principle of individualized treatment，sufficient drainage of the liver abscess，simultaneously or elective hepatectomy are the best treatment of liver abscess caused by cholelithiasis.

Key words: cholelithiasis, hepatolithiasis, liver abscess, hepatectomy