【摘要】：目的:探討"一站式"外科治療區(qū)域型肝膽管結(jié)石病的可行性。方法:回顧性分析2013年1月—2016年8月收治的74例區(qū)域型肝膽管結(jié)石病患者的臨床資料�；颊呔�"一站式"外科治療,即以規(guī)則性肝切除為基礎(chǔ),依靠術(shù)中B超和膽道鏡的指引,一次性去清結(jié)石、切除病變膽管及病損性肝臟。結(jié)果:74例患者中,術(shù)前影像學(xué)判斷結(jié)石分布符合率達(dá)94.6%(70/74)。74例均行規(guī)則性肝切除,左半肝切除21例,左外葉切除8例,右半肝切除17例,右后葉切除16例,右前葉切除4例,右后葉+左外葉切除5例,擴(kuò)大右半肝切除3例;行解剖性肝切除49例(66.2%);7例曾行膽腸內(nèi)引流患者中5例因吻合口狹窄加行吻合口重建;71例行T管引流術(shù),另外3例患者因重建膽腸吻合口后預(yù)留肝總管短未放置T管;平均手術(shù)時間(235.7±35.6)min,平均出血量(415.3±106.8)m L。無死亡病例,11例出現(xiàn)并發(fā)癥經(jīng)保守治療好轉(zhuǎn);術(shù)后平均住院時間為(9.2±4.1)d。6例術(shù)后膽道T管造影可疑結(jié)石,門診再行膽道鏡檢查或取石。所有患者獲隨訪3~24個月,2例曾行膽腸內(nèi)引流吻合口未重建者期間出現(xiàn)過1次膽道感染,保守治療好轉(zhuǎn);21例膽總管結(jié)石復(fù)發(fā)予以ERCP+EST處理。結(jié)論:嚴(yán)格的術(shù)前評估,選擇合適的病例,"一站式"外科治療區(qū)域型肝膽管結(jié)石病安全可行,且療效滿意。
[Abstract]:Objective: to investigate the feasibility of one-stop surgical treatment of regional hepatolithiasis. Methods: the clinical data of 74 patients with regional hepatolithiasis from January 2013 to August 2016 were retrospectively analyzed. All patients underwent "one-stop" surgical treatment, that is, on the basis of regular hepatectomy, depending on the guidance of B-ultrasound and choledochoscope, one-off removal of stones, removal of the diseased bile duct and the damaged liver. Results: the coincidence rate of preoperative imaging diagnosis was 94.6% (70 / 74). All 74 patients underwent regular hepatectomy, left half hepatectomy in 21 cases, left lateral lobectomy in 8 cases, right hemi hepatectomy in 17 cases, right posterior lobectomy in 16 cases, and regular hepatectomy in 21 cases, left lateral lobectomy in 8 cases, right half hepatectomy in 17 cases and right posterior lobe resection in 16 cases. There were 4 cases of right anterior lobectomy, 5 cases of left lateral lobectomy of right posterior lobe and 3 cases of extended right hemi-hepatectomy. Surgical hepatectomy was performed in 49 cases (66.2%), 5 of 7 patients who had undergone biliary and intestinal drainage underwent anastomotic reconstruction due to stricture of anastomotic orifice. 71 cases were treated with T-tube drainage, the other 3 cases had no T-tube reserved after reconstruction of choledochojejunostomy, the average operation time was (235.7 鹵35.6) min, the average bleeding volume was (415.3 鹵106.8) m L.). There were no death cases, 11 cases had complications improved by conservative treatment, the average postoperative hospitalization time was (9.2 鹵4.1) d.6 cases were suspected of choledocholithiasis by T-tube cholangiography after operation, and choledochoscopy or lithotomy were performed in the out-patient department. All the patients were followed up for 3 months for 24 months. Two patients who had not undergone reconstruction of choledochal drainage anastomoses had one biliary tract infection during which conservative treatment improved, and 21 patients with choledocholithiasis recurrence were treated with ERCP EST. Conclusion: the "one-stop" surgical treatment of regional hepatolithiasis is safe and feasible, and the curative effect is satisfactory.
【作者單位】： 安徽醫(yī)科大學(xué)附屬省立醫(yī)院膽胰外科/肝膽胰外科安徽省重點(diǎn)實(shí)驗(yàn)室;
【基金】：安徽省高等學(xué)校省級自然科學(xué)研究基金資助項(xiàng)目(KJ2013Z143)
【分類號】：R657.42

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