区域性肝胆管结石120例的外科手术治疗效果分析

摘要

目的 研究120例区域性肝胆管结石行外科手术的治疗效果.方法 选取我院收治的120例区域性肝胆管结石患者为研究对象,均行外科手术治疗,即在B超和胆道镜引导下,行腹腔镜规则性肝切除术,一次性取净结石和切除病变的肝脏、胆管,观察手术效果.结果 120例患者中,术前结石分布区域影像学诊断正确率为95.83％;均行规则性肝切除,左半肝切除34例,左外叶切除13例,右半肝切除28例,右后叶切除26例,右前叶切除6例,右后叶+左外叶切除8例,扩大右半肝切除5例;109例患者行胆总管T管外引流;行解剖性肝切除者80例(66.67％),平均手术时间(242.35±52.48) min,平均出血量(424.18±104.93) ml;均保守治疗或带管出院,无肝功能衰竭或死亡;出血3例,腹腔内脓肿5例,胆汁漏10例,并发症总发生率为15％;平均住院时间(8.59 ±2.36)d,出院前常规肝脏CT和B超检查,发现10例胆总管内疑有结石,门诊复查时有6例胆道镜取出结石,随访时有32例胆总管结石复发,复发率为26.67％,均给予逆行胰胆管造影(ERCP)±十二指肠乳头括约肌切开术(EST)取净结石.结论 外科手术治疗区域性肝胆管结石安全有效,可全面评估患者病情,完善手术方案,降低术后并发症和结石复发发生率.%Objective To explore the treatment effects of surgery for 120 cases of regional hepatolithiasis.Methods 120 cases of patients with regional hepatolithiasis treated in our hospital were selected for the study and treated with "one-stop" surgery,that is,the patients were given the laparoscopic regular hepatectomy,disposable stone removal and the resection of diseased liver and bile duct under the guidance of B-mode ultrasound and choledochoscope.The surgrical effect was observed.Results The imaging diagnosis accuracy rate of preoperative stone distribution area was 95.83％ among the 120 cases of patients.All the patients were given hepatectomy,including 34 cases of left hepatectomy,13 cases of left lateral lobectomy,28 cases of right hepatectomy,26 cases of right posterior lobectomy,6 cases of right anterior lobectomy,8 cases of right posterior lobe and left lateral lobectomy and 5 cases of extended right hepatectomy.T drainage of the common bile duct was performed among 109 cases of patients.80 cases (66.67％) of patients were given the anatomical hepatectomy with the average operative time of (242.35 ±52.48) min and the average volume of bleeding of (424.18 ± 104.93) ml.All patients were treated conservatively or discharged from the hospital,and there was no liver failure or death.There were 3 cases of bleeding,5 cases of intra-abdominal abscess and 10 cases of bile leakage,and the total incidence of complications was 15％.The average hospital stay were(8.59 ±2.36) d,and the routine liver CT and B ultrasonic examination were given before discharge and there were 10 cases of suspected stones in the common bile duct.And there were 6 cases were removed of stones by choledochoscope during the outpatient review,and there were 32 cases of choledocholithiasis recurrence with the recurrence rate of 26.67％ during follow-up,and they were given the endoscopic retrograde cholangiopancreatography (ERCP) and total duodenal endoscopic sphincterotomy (EST) to remove the stones.Conclusions Surgery surgerycan have a safe and effective effect on regional hepatolithiasis,and it can comprehensively assess the patient' s condition,and improve the surgery methods and reduce the incidence rates of postoperative complications and stones recurrence.