胆石症专题研究(Monographic Study of Cholelithiasis)

单纯切除病变胆管分支治疗右肝区域性胆管结石的疗效分析

Published at: 2015年第24卷第8期

吴荣寿 1 , 邬林泉 1 , 殷香保 1 , 周凡 1 , 邵江华 1 , 张惊玲 2
1 南昌大学第二附属医院 肝胆外科,江西 南昌 330006
2 南昌大学第一附属医院 麻醉科,江西 南昌330006
通讯作者 林泉 邬 Email: Wulqnc@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.004
基金:
江西省科学技术厅科技计划资助项目 NO1254

摘要

目的:探讨单纯切除病变胆管分支治疗右肝区域性胆管结石的临床疗效。方法:回顾性分析2008 年11 月—2014 年11 月19 例右肝区域性胆管结石行单纯病变胆管分支切除的患者资料。结果:19 例患者中,男8 例,女11 例;9 例有胆道手术史;结石均局限于V、VI 或VII 段的3 级及以上胆管。患者手术方式均为单纯病变胆管分支切除,即根据术前影像学资料和术中B 超检查,确定病变胆管根部位置及结石范围,切除包括病变胆管及其周围受损的肝组织,不行常规胆囊切除和胆管引流。手术出血量100~500 mL,手术时间2~4.5 h,肝门阻断时间10~20 min。术后胆瘘3 例,胸水1 例,膈下脓肿1 例,结石残留1 例;住院期间无死亡病例。17 例患者获得随访3~72 个月,其中2 例患者行CT、MRI 检查可疑结石复发,其他患者无临床症状且检查无结石复发,生活质量优良率88.2%。结论:对于肝胆管结石仅局限于V、VI 或VII 段的3 级及以上胆管的患者,可采取单纯切除病变胆管分支的手术方式,且具有较好的疗效。


Clinical efficacy of simple resection of affected bile ducts for right-sided regional hepatolithiasis

Abstract

Objective: To investigate the clinical efficacy of simple resection of the affected bile ducts for right-sided regional hepatolithiasis. Methods: The clinical data of 19 patients with right-sided regional hepatolithiasis undergoing simple resection of the affected bile ducts from November 2008 to November 2014 were retrospectively analyzed. Results: Of the 19 patients, 8 cases were males and 11 cases were females; 9 cases had a history of biliary surgery, and stones in all cases were locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII. All patients underwent simple resection of the affected bile ducts, namely, excision of the affected bile ducts along with the surroundings impaired hepatic tissues after determination of the location of the root of the affected bile ducts and range of the stones according to preoperative imaging data and intraoperative ultrasound examination, without routine cholecystectomy and biliary drainage. The intraoperative blood loss was 100-500 mL, operative time was 2–4.5 h, and time of total hepatic inflow occlusion was 10–20 min. Bile leakage occurred in three cases, and pleural effusion, subphrenic abscess and residual stones were found in one case each after operation; no death occurred during hospitalization. Seventeen patients were followed up for 3–72 months, two patients had suspicious stone recurrence found by CT and MRI examination, but no clinical symptoms or stone recurrence was noted in the remaining patients, and the rate of excellent quality of life was 88.2%. Conclusion: Simple resection of the affected bile ducts may have a good effect in patients with stones locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII.


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引用

引用本文: 荣寿 吴, 林泉 邬, 香保 殷, 凡 周, 江华 邵, 惊玲 张. 单纯切除病变胆管分支治疗右肝区域性胆管结石的疗效分析[J]. 中国普通外科杂志, 2015, 24(8): 1077-1082.
Cite this article as: WU Rongshou, WU Linquan, YIN Xiangbao, ZHOU Fan, SHAO Jianghua, ZHANG Jingling . Clinical efficacy of simple resection of affected bile ducts for right-sided regional hepatolithiasis[J]. Chin J Gen Surg, 2015, 24(8): 1077-1082.