多处肝切除治疗复杂肝胆管结石病手术71例分析

摘要

目的:分析并评价采用多处肝切除手术治疗复杂肝胆管结石的手术方法,探讨如何在提高手术疗效的同时降低并发症的发生率.方法:对我院自2002年10月至2010年12月期间收治的71例复杂肝胆管结石病患者,采用多处肝切除手术进行治疗,分析并评价多处肝切除手术方法的临床治疗效果.结果:顺利完成肝内胆管结石清除手术者52例,清除率为73.2%,残留结石19例,术后3～6 个月通过T管窦道胆道镜取石患者17例,结石取净15例,最终结石清除率为94.4%.随访5～8年,平均84个月,有5例肝内胆管结石复发,未见肝内胆管癌与死亡病例.结论:采用多处肝切除手术在治疗复杂肝胆管结石方面的临床疗效令人满意,但仍不能降低手术并发症的发生率.%Objective:To analyze and evaluate the use of multiple hepatectomy operation treatment of complicated hepatolithiasis operation method, discusses how to improve operation effect and reduce the incidence of complications.Methods:In our hospital from 2002 October to 2010 December, 71 cases of complex hepatolithiasis patients, using multiple hepatic resection operation for treatment, analysis and evaluation of multiple hepatic resection operation methods of clinical treatment effect.Results:The successful completion of intrahepatic bile duct stone removal operation in 52 cases, removal rate is 73.2%, the residual calculi in 19 cases, after 3 ~ 6 months through the T tube sinus endoscope of biliary tract stone 17 cases, net extraction in 15 cases, eventually the stone-free rate was 94.4%. Conclusion:The use of multiple hepatic resection operation in the treatment of complicated hepatolithiasis with respect to clinical outcome is satisfactory, but still cannot reduce operation complication. To ensure the smooth completion of multiple hepatic resection operation with respect to need to do the following: the involvement of range accurate assessment; judge the appropriateness of the hepatic resection types; try to maintain the normal liver tissues; the implementation of conventional choledochotomy and T tube drainage; to avoid accidental injury of intrahepatic normal tissue structure.