尾叶胆管残余结石手术治疗体会

目的总结尾叶胆管残余结石的外科手术处理经验。方法回顾性分析29例尾叶胆管残余结石病例的临床资料：残余结石分布于Ⅸ段12例,Ⅰ段10例,Ⅸ及Ⅰ段7例;Ⅸ段狭窄7例,Ⅰ段狭窄5例;右后叶胆管、Ⅸ段胆管共干8例,Ⅸ、Ⅰ段共干5例;Ⅸ段肥大5例,Ⅰ段肥大4例,Ⅸ及Ⅰ段肥大3例。5例行尾叶胆管切开、扩张、成形,7例行尾叶切除,17例行尾叶胆管取石。结果术后无胆漏、腹腔内大出血等严重并发症,术后尾叶再次残余结石5例,残石率17.2%。平均随访2.5年（3月~4年）,3例仍出现右上段腹胀痛不适,优良率89.7%（26/29）。结论术中仔细探查尾叶胆管是减少残石的关键,尾叶胆管残石处理原则为：充分取尽结石,解除狭窄,切除病肝,通畅胆汁引流。

Surgical Treatment of Retained Calculi of Caudate Hepatic Duct

Objective To discuss the surgical treatment of retained calculi of caudate hepatic duct.Methods Clinical causes of 29 cases of remaining stone of caudate hepatic duct were retrospectively analyzed.The residual stones were located in the segment Ⅸ of 12 cases,segment Ⅰof 10 cases,and both in the two segments of 7cases.There were bile duct strictures in 7 cases of segment Ⅸ and 5 of segment Ⅰ.There were 13 cases of bile duct variation,including 8 co-trunks of right posterior lobe and the segment Ⅸ,and 5 co-trunks of the segment Ⅸ andⅠ.And abnormal liver shape and disproportion was observed in 5 cases of Ⅸ hypertrophy,4 of Ⅰhypertrophy,and 3 of both the two segments hypertrophy.In all 29 cases,5 cases was performed incision,dilatation and plasty of caudate hepatic duct,7 cases performed caudate lobectomy,and 17 cases performed extracting stone through the caudate hepatic duct. Results There was no severe complication such as biliary fistula or massive hemorrhage.The postoperative stone remaining rate was 17.2%（5/29）.During the 3 months to 4 years follow-up,all the cases lived with good life quality except 3 cases with symptoms of cholangiolitis.Conclusion Careful exploration of the caudate hepatic duct is the key step of reducing remaining stone.Treatment principles of remaining stone of caudate hepatic duct include extracting stone as possible,eliminating stricture and resecting focal liver with expedite drainage of bile.