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

第二肝门附近复杂性肝胆管结石的外科处理

Published at: 2015年第24卷第8期

李恩亮 1 , 邬林泉 1 , 袁荣发 1 , 刘万伟 1 , 殷香保 1 , 邵江华 1
1 南昌大学第二附属医院 肝胆外科,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.1005-6947.2015.08.005
基金:

摘要

目的:探讨经第二肝门区域肝实质切开取石处理第二肝门附近复杂性肝胆管结石的临床疗效。方法:回顾性分析2008 年1 月—2014 年1 月收治的28 例第二肝门附近复杂性肝胆管结石患者的临床与手术资料。结果:患者结石主要集中于II、IV、VIII 段;手术方法以第二肝门区域肝实质切开取石术为主,结合胆总管切开取石术或肝部分切除术;住院期间患者死亡1 例,术后并发症发生率14.8%。25 例患者随访1~4 年,术后结石清除率81.5%,术后再次经胆道镜取石后,最终结石清除率92.6%;结石复发率为11.1%。结论:经第二肝门区域肝实质切开取石术治疗第二肝门附近复杂性肝胆管结石,尤其是无法耐受多肝段切除的患者,具有一定的疗效。


Surgical management of complicated bile duct stones around second porta hepatis

Abstract

Objective: To investigate the clinical efficacy of lithotomy through incision of the second portal region parenchyma for complicated bile duct stones around the second porta hepatis. Methods: The clinical data of 28 patients with complicated bile duct stones around the second porta hepatis admitted during January 2008 to January 2014 were retrospectively analyzed. Results: In these patients, the stones were largely located in segment II, IV and VIII; lithotomy through incision of the second portal region parenchyma was the main surgical procedure performed, in addition with choledocholithotomy or partial hepatectomy. Death during hospitalization occurred in one case, and the incidence of postoperative complications was 14.8%. Twenty-five patients were followed up for one year to 4 years, postoperative stone clearance rate was 81.5% and final clearance rate was 92.6% after postoperative choledochoscopic lithotripsy, and the stone recurrence rate was 11.1%. Conclusion: Lithotomy through incision of the second portal region parenchyma offers certain efficacy for patients with complicated bile duct stones around the second porta hepatis, especially those unable to tolerate multisegmentectomy.


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引用

引用本文: 恩亮 李, 林泉 邬, 荣发 袁, 万伟 刘, 香保 殷, 江华 邵. 第二肝门附近复杂性肝胆管结石的外科处理[J]. 中国普通外科杂志, 2015, 24(8): 1083-1087.
Cite this article as: LI Enliang, WU Linquan, YUAN Rongfa, LIU Wanwei, YIN Xiangbao, SHAO Jianghua . Surgical management of complicated bile duct stones around second porta hepatis[J]. Chin J Gen Surg, 2015, 24(8): 1083-1087.