肝内胆管结石外科手术方法探讨
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杨忠义

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Study of therapeutic effects of surgical treatment of intrahepatic cholelithiasis
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    目的: 探讨肝内胆管结石并狭窄的手术治疗方法及其效果。方法: 总结8年间住院的165例肝内胆管结石并胆管狭窄患者的外科手术治疗情况。其中A组85例行肝叶(或肝段)切除的各种术式,同时行胆管空肠吻合40例,肝断面扩张胆管、肝门胆管与空肠双口吻合10例,T管和U管引流分别为21例和14例;B组80例行非肝叶(或肝段)切除术的各种术式,其中胆总管切开取石+T管引流23例,胆总管切开取石+U形管引流15例,胆肠吻合+胆总管取石42例。肝门部肝胆管狭窄整形46例。结果: A组无手术死亡;随访2~7年,术后残留结石4例,残石率4.71%;症状复发3例,复发率3.53%,无再手术者。B组无手术死亡;B组随访2~7年,术后残留结石12例,残石率15.00%。10例术后常有上腹隐痛或发热,症状复发率12.5%。术后经胆道镜取石5例,其余6例中有3例再次行肝叶切除治愈。结论: 肝段(叶)切除联合其他手术是治疗肝内胆管结石较为理想而有效的手术方式。

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    Abstract:Objective:To evaluate retrospectively the methods and outcomes of surgical treatment of patients with intrahepatic cholelithiasis and biliary stricture. Methods:The data of the surgical therapy of 165 cases of cholelithiasis and biliary stricture admitted between January 1995 and January 2003 were analyzed. Group A included 85 cases managed by various types of hepatectomy or hepatic segmental resection(HSR). In group A, 40 patients underwent simultaneous cholangiojejunostomy, in 10 patients the dilated bile duct on resected surface of liver and bile duct of hepatic hilum were separately anastomosed to the jejunum by double stoma anostomosis, T-tube drainage was done in 21 cases and U-tube drainage in 14 cases. Group B patients(n=80) were treated by operation without HSR, included 23 cases with choledochotomy and stone removal plus T-tube drainage, 15 cases with choledochotomy and stone removal plus U-tube drainage, 42 cases with choledochotomy and stone removal plus biliary-enteric anastomosis; in group B, plastic operation of the hepatic duct stricture was proforemed in 46 cases. Results:In Group A, no operative death occurred. The cases were followed up after operation from 2 to 7 years, and showed residual calculus rate was 4.71%, and symptoms recurrence rate 3.53%. No patient was operated again. In Group B, no operative death occurred. The cases were followed up from 2 to 7 years after operation, and residual stones were found in 12 cases, a residual calculus rate of 15.00%. After operation, 10 cases complained of upper abdominal pain and fever, with a symptoms recurrence rate of 12.5%. The residual stones of 5 cases were removed by fiber biliary endoscopy, while 3 cases of the other 6 cases received hepatectomy. Conclusions:The combined hepatic resection and other operation is an ideal and effective surgical method to treat hepatolithiasis.

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杨忠义,苗雄鹰,刘鸿程,胡雄.肝内胆管结石外科手术方法探讨[J].中国普通外科杂志,2006,15(3):14-213.
DOI:10.7659/j. issn.1005-6947.2006.03.013

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  • 在线发布日期: 2006-03-25