【摘要】：目的:探討"一站式"外科治療區(qū)域型肝膽管結石病的可行性。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,依靠術中B超和膽道鏡的指引,一次性去清結石、切除病變膽管及病損性肝臟。結果:74例患者中,術前影像學判斷結石分布符合率達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,另外3例患者因重建膽腸吻合口后預留肝總管短未放置T管;平均手術時間(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;術后平均住院時間為(9.2±4.1)d。6例術后膽道T管造影可疑結石,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;21例膽總管結石復發(fā)予以ERCP+EST處理。結論:嚴格的術前評估,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)科大學附屬省立醫(yī)院膽胰外科/肝膽胰外科安徽省重點實驗室;
【基金】：安徽省高等學校省級自然科學研究基金資助項目(KJ2013Z143)
【分類號】：R657.42

【相似文獻】

相關期刊論文 前10條

1 鞏本剛,張同軍,夏修良,王建強,成丕光;高齡肝膽管結石病人的外科手術治療[J];濱州醫(yī)學院學報;2004年05期

2 韓殿冰;董家鴻;郭光金;;對1259例肝膽管結石病臨床病理分型評價[J];第三軍醫(yī)大學學報;2006年12期

3 陸詠江;;肝膽管結石病的診斷與治療方案選擇[J];航空航天醫(yī)藥;2006年04期

4 韓殿冰;董家鴻;;規(guī)則性肝葉切除術在治療肝膽管結石病中的作用[J];局解手術學雜志;2008年03期

5 盧綺萍;;關于肝膽管結石病的治療理念和認識上的進步——學習《肝膽管結石病診斷與治療指南》有感[J];腹部外科;2008年02期

6 李青;;規(guī)則性和非規(guī)則性肝葉切除術對肝膽管結石病的療效比較[J];中國現(xiàn)代醫(yī)學雜志;2011年35期

7 鄭亞新;;肝膽管結石病的診斷和治療[J];上海醫(yī)藥;2012年20期

8 鄭亞新;;肝膽管結石病的診斷和治療[J];上海醫(yī)藥;2012年22期

9 呂文平;;肝膽管結石病的臨床分型與手術方式選擇[J];臨床肝膽病雜志;2013年06期

10 張府桓;雷正明;;肝膽管結石病治療進展[J];武警后勤學院學報(醫(yī)學版);2013年08期

相關博士學位論文 前3條

1 韓殿冰;肝膽管結石病診斷治療方法的效果評價[D];第三軍醫(yī)大學;2006年

2 伍天崇;復雜肝膽管結石病3D技術指導下外科綜合診療效果的評價研究[D];南方醫(yī)科大學;2014年

3 樓健穎;術后膽道鏡取石和肝臟切除術在肝膽管結石病治療中的評價[D];浙江大學;2012年

相關碩士學位論文 前3條

1 侯德智;肝膽管結石病的臨床分型及其各型手術方式選擇的分析[D];昆明醫(yī)科大學;2014年

2 石小舉;肝膽管結石病的綜合治療[D];吉林大學;2010年

3 謝杭;肝切除術治療肝膽管結石�。ǜ�341例報告）[D];福建醫(yī)科大學;2008年

，

本文編號：2441526