专题研究(Monographic Study)

区域型肝胆管结石病的“一站式”处理:附74例报告

Published at: 2017年第26卷第2期

刘臣海 1 , 黄强 1 , 朱成林 1 , 汪超 1
1 安徽医科大学附属省立医院 胆胰外科/肝胆胰外科安徽省重点实验室,安徽 合肥 230001
通讯作者 强 黄 Email: 28628865@qq.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.02.001
基金:
安徽省高等学校省级自然科学研究基金资助项目 KJ2013Z143

摘要

目的:探讨“一站式”外科治疗区域型肝胆管结石病的可行性。方法:回顾性分析2013年1月—2016年8月收治的74例区域型肝胆管结石病患者的临床资料。患者均行“一站式”外科治疗,即以规则性肝切除为基础,依靠术中B超和胆道镜的指引,一次性去清结石、切除病变胆管及病损性肝脏。结果:74例患者中,术前影像学判断结石分布符合率达94.6%(70/74)。74例均行规则性肝切除,左半肝切除21例,左外叶切除8例,右半肝切除17例,右后叶切除16例,右前叶切除4例,右后叶+左外叶切除5例,扩大右半肝切除3例;行解剖性肝切除49例(66.2%);7例曾行胆肠内引流患者中5例因吻合口狭窄加行吻合口重建;71例行T管引流术,另外3例患者因重建胆肠吻合口后预留肝总管短未放置T管;平均手术时间(235.7±35.6)min,平均出血量(415.3±106.8)mL。无死亡病例,11例出现并发症经保守治疗好转;术后平均住院时间为(9.2±4.1)d。6例术后胆道T管造影可疑结石,门诊再行胆道镜检查或取石。所有患者获随访3~24个月,2例曾行胆肠内引流吻合口未重建者期间出现过1次胆道感染,保守治疗好转;21例胆总管结石复发予以ERCP+EST处理。结论:严格的术前评估,选择合适的病例,“一站式”外科治疗区域型肝胆管结石病安全可行,且疗效满意。


"One-stop" treatment of regional hepatolithiasis: a report of 74 cases

Abstract

Objective: To investigate the feasibility of “one-stop” surgical treatment for regional hepatolithiasis. Methods: The clinical data of 74 patients with regional hepatolithiasis admitted from January 2013 to August 2016 were retrospectively analyzed. All patients underwent “one-stop” surgical treatment, i.e., one-session performance of complete stone removal and resection of the biliary strictures and impaired portion of the liver based on regular liver resection and guided by intraoperative B-type ultrasonography and cholangioscopy. Results: In the 74 patients, the coincidence rate of stone distributions by preoperative imaging examinations was 94.6% (70/74). All patients underwent regular hepatectomy that included left hemihepatectomy in 21 cases, left lateral lobectomy in 8 cases, right hemihepatectomy in 17 cases, right posterior lobectomy in 16 cases, right anterior lobectomy in 4 cases, right posterior lobectomy plus left lateral lobectomy in 5 cases and extended right hemihepatectomy in 3 cases; anatomical hepatectomy was performed in 49 patients (66.2%); 5 of the 7 cases who had internal biliary-intestinal drainage previously underwent additional reconstruction of the anastomosis due to anastomotic stenosis; 71 cases underwent T-tube drainage, the other 3 cases did not undergo T-tube placement due to short length of the preserved common hepatic duct after reconstruction of the anastomosis; the average operative time was (235.7±35.6) min and the average of blood was (415.3±106.8) mL. No deaths occurred, and postoperative complications occurred in 11 patients, all of which were improved by conservative treatments; the average length of postoperative hospital stay was (9.2±4.1) d. Six patients with suspicious residual stones by postoperative T-tube cholangiography underwent outpatient cholangioscopy or stone extraction. All patients were followed-up for 3 to 24 months, biliary infection occurred once in the 2 cases who did not undergo reconstruction of the anastomosis of the previous biliary-intestinal drainage, and 21 patients had stone recurrence in the common bile duct and were treated by ERCP+EST. Conclusion: After rigorous preoperative evaluation and selection of suitable patients, “one-stop” surgical treatment for regional hepatolithiasis is safe and feasible, with favorable efficacy.


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引用

引用本文: 臣海 刘, 强 黄, 成林 朱, 超 汪. 区域型肝胆管结石病的“一站式”处理:附74例报告[J]. 中国普通外科杂志, 2017, 26(2): 133-138.
Cite this article as: LIU Chenhai, HUANG Qiang, ZHU Chenglin, WANG Chao . "One-stop" treatment of regional hepatolithiasis: a report of 74 cases[J]. Chin J Gen Surg, 2017, 26(2): 133-138.