【摘要】：目的:探討術(shù)中超聲輔助下病變膽管區(qū)肝切除治療區(qū)域性肝膽管結(jié)石的臨床療效。方法:對(duì)2012年10月—2015年6月間,將超聲輔助下病變膽管區(qū)肝切除的27例區(qū)域性肝膽管結(jié)石患者的臨床資料進(jìn)行回顧性分析。結(jié)果:27例患者中,男16例,女11例;平均年齡(46.4±8.3)歲。7例有膽道手術(shù)史。結(jié)石分布于S4(2例),S5(8例),S6(10例),S8(4例),S5+S8(3例)。所有患者均采用超聲輔助下的病變膽管區(qū)的肝切除。平均術(shù)中出血量為(336.3±94.3)m L,平均手術(shù)時(shí)間為(235.9±37.8)min,平均住院時(shí)間為(12.5±2.4)d。5例出現(xiàn)術(shù)后并發(fā)癥,包括膽汁漏2例,切口感染3例。經(jīng)殘端膽管行膽道探查16例中發(fā)生并發(fā)癥2例;行膽總管切開(kāi)探查者11例中發(fā)生并發(fā)癥3例,兩者并發(fā)癥發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。24例患者獲得隨訪,隨訪時(shí)間3~36個(gè)月,1例發(fā)生肝外膽管結(jié)石,經(jīng)EST治愈,其余患者無(wú)結(jié)石復(fù)發(fā)及臨床癥狀。結(jié)論:對(duì)于區(qū)域性肝膽管結(jié)石患者,可采用超聲輔助下的病變膽管區(qū)肝切除,術(shù)中膽道探查應(yīng)首選經(jīng)肝斷面殘端膽管進(jìn)行。
[Abstract]:Objective: to evaluate the effect of intraoperative ultrasound-assisted hepatectomy on regional hepatolithiasis. Methods: the clinical data of 27 patients with regional hepatolithiasis were retrospectively analyzed from October 2012 to June 2015. Results: of the 27 patients, 16 were male and 11 were female, with an average age of (46.4 鹵8.3) years. Stones were found in S4 (2 cases), S5 (8 cases), S6 (10 cases), S8 (4 cases) and S5 S8 (3 cases). All patients were treated with ultrasound-assisted hepatectomy of the diseased bile duct area. The average intraoperative bleeding volume was (336.3 鹵94.3) m L, the mean operation time was (235.9 鹵37.8) min, the average hospitalization time was (12.5 鹵2.4) days, including bile leakage in 2 cases, incision infection in 3 cases. Complications occurred in 2 out of 16 patients who underwent biliary exploration via stump bile duct. Complications occurred in 3 out of 11 patients who underwent choledocholithotomy (P0.05). 24 patients were followed up for 3 ~ 36 months. One patient developed extrahepatic cholelithiasis and was cured by EST. The other patients had no recurrence and clinical symptoms. Conclusion: for the patients with regional hepatolithiasis, ultrasonic assisted hepatectomy of the diseased bile duct should be adopted. The exploration of biliary tract should be carried out first through the remnant bile duct of the liver section during the operation.
【作者單位】： 成都軍區(qū)總醫(yī)院全軍普通外科中心;
【基金】：四川省青年科技創(chuàng)新研究團(tuán)隊(duì)資助項(xiàng)目(2011JTD0010)
【分類號(hào)】：R657.42

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