| 摘要: |
| 目的：总结尾状叶胆管结石的外科治疗经验，提高尾状叶胆管结石的诊治水平。方法：回顾性分析2000年1月至2006年12月19例尾状叶胆管结石患者的一般资料、手术方式、术后并发症及随访情况。结果：19例患者男8例、女11例，既往共行30次胆道手术，其中12例1次、4例2次、2例3次、1例4次。术前均行B超、CT或MRCP、ERCP等检查证实尾状叶胆管结石。14例伴有尾状叶胆管开口狭窄。11例行尾状叶切除术，8例行尾状叶胆管开口扩张或切开整形+探查取石术，手术成功率100％，术后无结石残留。18例(94.7％)获随访，平均随访(17.6±2.3)个月，2例出现结石复发，优良率88.9％，其中行尾状叶切除术患者优良率达100％。结论：尾状叶胆管结石的处理相当复杂和困难，仅行胆管探查取石往往效果不佳，尾状叶切除术可达到清除病灶的目的，有良好的远期效果，但需要临床医师具备丰富的肝脏外科经验和娴熟的手术操作水平。 |
| 关键词: 胆结石 肝内胆管 肝尾状叶 肝切除术 |
| DOI：10.3724/SP.J.1008.2008.00614 |
| 投稿时间：2008-03-04修订日期：2008-04-28 |
| 基金项目: |
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| Surgical treatment of caudate hepatolithiasis |
| LU Jun-hua1△,YANG Tian1△,ZHU Yi-liang2,TANG Jun3,YANG Guang-shun1* |
| (1.Department of 2nd Biliary Tract Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China;2.Department of General Surgery,Maanshan People’s Hospital,Ma’anshan 245000;3.Department of General Surgery,Traditional Chinese Medicine Hospital of Jingjiang,Jingjiang 214500) |
| Abstract: |
| Objective：To summarize our experience on surgical treatment of caudate hepatolithiasis,so as to improve the diagnosis and treatment of caudate hepatolithasis.Methods: The clinical data,mode of operation,post-operation complications, and follow-up findings were retrospectively analyzed in 19 patients with caudate hepatolithasis from Jan.2000 to Dec.2006.Results: The 19 cases included 8 males and 11 females.Totally they had undergone 30 times of operation,with 12 cases only had once,4 had twice,2 had thrice,and 1 had 4 times.All cases received B ultrasound,CT, MRCP or ERCP and were confirmed to have caudate hepatolithiasis.Fourteen cases were complicated with opening stonosis of caudate bile duct.Eleven cases received caudate lobe resection.Eight cases received caudate expansion of the bile duct or plastic repair of duct + caudate duct exploration and calculus extraction, with a success rate of 100% and the patients were stone-free after surgery.Eighteen patients (94.7%) were followed up for a mean of (17.6±2.3 ) months.Two cases had stone recurrence.The excellent and good rate was 88.9% in the present cohort; all those who received resection of the caudate lobe had excellent or good outcomes.Conclusion: It is very complex and difficult to treat caudate bile duct stone; caudate duct exploration and calculus extraction usually have unsatisfactory outcomes.Caudate lobe resection can clear the lesions and has a good long-term effect,which is largely dependent on the rich experience and the skillfulness of the surgeons. |
| Key words: cholelithiasis intrahepatic bile ducts liver caudate lobe hepatectomy |
