肝胆管结石行肝段联合切除中的手术策略
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罗昆仑, Email: lkl197041@yahoo.com.cn

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Surgical strategy of liver segmentectomy for hepatolithiasis
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    摘要:

    目的:评价多肝段联合切除治疗复杂肝胆管结石的效果。 方法:回顾性分析93 例肝胆管结石患者行多肝段联合切除术的临床资料。术式包括行右半肝切除 5 例,右后叶切除7 例,右后叶切除加肝左外叶切除2 例,肝Ⅷ段加尾状叶切除1 例,肝Ⅷ段加 左外叶切除3 例,肝Ⅶ,Ⅷ段次全切除加左外叶切除术2 例,右前叶切除5 例,肝Ⅳ,Ⅴ段切除2 例, 肝Ⅳ,Ⅴ,Ⅷ段次全切除5 例,左半肝切除19 例,左半肝加尾状叶切除4 例,肝Ⅳ段切除6 例,左 外叶切除32 例。附加手术包括胆肠吻合术22 例;所有患者行胆囊切除,胆道镜检查和/ 或取石, 术后胆总管T 管引流。 结果:全组无手术死亡病例。发生并发症17 例(18.2%),其中胆瘘2 例(2.2%),膈下感染1 例(1.1%), 切口感染6 例(6.4%),肺部感染3 例(3.2%),胸腔积液6 例(6.4%),应激性溃疡2 例(2.2%),均 经治疗痊愈出院。术后发现残石9 例,经胆道镜取净结石5 例。全组随访89 例(95.7%)。3 例合 并胆管癌的患者死于胆管癌复发,3 例胆管结石复发。 结论:以多肝段联合切除为主的手术方式是治疗肝胆管结石的有效手段。

    Abstract:

    Objective: To evaluate the efficacy of multiple hepatic segmentectomies for complex hepatolithiasis. Methods: The clinical data of 93 patients with hepatolithiasis who underwent multiple liver segmentectomies were retrospectively analyzed. The procedures included 5 cases of right lobectomy, 7 cases of right posterior lobectomy, 2 cases of right posterior lobe plus left lateral lobe resection, 1 case of segment VIII plus caudate lobectomy, 3 cases of segment VIII and left lateral lobe resection, 2 case of subtotal segment VII and VIII plus left lateral lobe resection, 5 cases of right anterior lobectomy, 2 cases of segment IV and V resection, 5 cases of segment IV, V and VIII resection, 19 cases of left lobectomy, 4 cases of left and caudate lobectomy, 6 cases of segment IV resection, and 32 cases of left lateral lobectomy. Additional choledochojejunostomy was performed in 22 cases. All the patients underwent cholecystectomy, cholangioscopic exploration and/or stone extraction, and common bile duct T-tube drainage. Results: There was no operative mortality. Postoperative complications occurred in 17 cases (18.2%),including 2 cases of bile leakage (2.2%), 1 case of subphrenic infection (1.1%), 6 cases of wound infection (6.4%), 3 cases of pulmonary infection (3.2%), 6 cases of pleural effusion (6.4%), and 2 cases of stress ulcer (2.2%). All of these complications resolved before the patients were discharged. In 9 cases, residual stones were found after operation and they were completely removed by cholangioscopy in 5 of them. Follow-up was obtained in 89 cases (95.7% of the whole group), of whom 3 cases with concomitant cholangiocarcinoma died of tumor recurrence and 3 cases developed bile duct stone recurrence. Conclusion: Multi-segmentectomies as the main operation modality is effective in the treatment of complex hepatolithiasis.

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罗昆仑|方征|余锋|刘洪|田志强|董志涛.肝胆管结石行肝段联合切除中的手术策略[J].中国普通外科杂志,2012,21(2):127-131.
DOI:10.7659/j. issn.1005-6947.2012.02.001

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  • 收稿日期:2011-10-11
  • 最后修改日期:2012-01-06
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  • 在线发布日期: 2012-02-15