肝内胆管结石合并肝门部胆管狭窄的手术处理分析

目的探讨肝内胆管结石并肝门部胆管狭窄的手术方法。方法回顾性分析我院47例肝内胆管结石并肝门部胆管狭窄手术治疗的临床资料,遵循“清除结石,解除狭窄,切除病肝,通畅引流”的原则,我们采取病肝切除、术中胆道镜检查、取石,肝门部胆管狭窄整形,胆肠R oux-en-Y大盆口吻合,空肠盲袢皮下埋置等综合治疗。术后常规消炎利胆片或中医中药预防结石复发。结果治愈45例(95.7%)。术前黄疸深重,术中渗血不止,停止手术,死亡1例,术后46天胃瘫并衰竭死亡1例。术后发现残留结石4例(8.7%),结石复发3例(6.5%),优良率93.7%;术后并发胆汁漏3例(6.5%),残留结石术后6周经T管窦道取净结石4例。结石复发的3例中经切开皮下空肠盲袢纤维胆道镜取石成功1例,再手术切除狭窄胆肠吻合口,重新行胆管空肠吻合,并应用纤维胆道镜取石2例。结论术前完善的检查对于了解肝内胆管结石的分布及肝门部胆管狭窄的范围有着重要的意义并能为手术方案的制订提供积极的指导作用。病变肝叶或肝段切除、肝门部狭窄胆管大范围切开整形、术中应用纤维胆道镜检查、取石、并建立皮下便捷通道的肝胆管空肠R oux-en-Y大盆口吻合是治疗该疾病的首选综合治疗方法。术后常规用药预防结石复发也是必要的。

Surgical therapy of intrahepatic bile duct stones with hepatic portal bile duct stricture

Objective To evaluate the curative effect of surgery in intrahepatic bile duct stones with hepatic portal bile duct stricture.Methods The clinical data of 47 patients were treated by the comprehensive treatment,including elimination of hepatolith,correction of biliary duct stenosis and cholangiojejunostomy,choledochoscope were employed during operation,and after operation the patients were treated with drugs.Results 45 patients(95.7%)were cured.Residual stone in 4 cases(8.7%) and recurrent of lithiasis in 3 cases(6.5%) were found.The excellent effective rate was 93.7%.One patient died from gastric paralysis after 46 days,another one was stopping operation and died from oozing blood after operation.Four patients with residual stone successfully performed intrahepatic stone removed operation with choledochoscope through T-tube drainage in 6 weeks.Three patients with recurrent stones successfully performed intrahepatic stone removed operation with choledochoscope through the subcutaneous blind loop or incision of common bile duct after rebuild hepatocholangioenterostomy.Conclusion Before the operation,the perfect of examination is important,and eliminalion of hepatolith,correction of biliary cluct stenosis and cholangiojejunostomy,employing choledochoscope during operation are comprehensive treatment and the drugs are necessary after operation.