左肝叶切除术治疗肝内胆管结石26例体会

目的探讨复杂的肝内胆管结石的手术方法。方法回顾性分析1994年5月-2007年5月收治的26例肝内胆管结石患者,实施左半肝切除6例,肝左外叶切除20例,肝断面取石并左肝管与胆总管会师取尽结石,矫治胆道狭窄,对合并右肝管结石者加用胆肠吻合术,术后带T管口服中药2～3周,并观察疗效。结果 1例高龄患者因胆总管十二指肠舌状切除术后出现吻合口漏而死亡,25例痊愈出院,T管拔除前造影均未见残余结石;随访25例,随访时间8月～10年,18例症状完全消失,6例有轻度胆管炎症状,需经常服用消炎利胆药物;1例术后5年胆管结石复发,加作Roux-Y胆肠吻合术后症状消失。总优良率达96%。结论左肝叶切除术治疗肝内胆管结石远期疗效满意。

Left Hepatic Lobe Resection for Intrahepatic Bile Duct Stones Report of 26 Cases

Objective To explore the complex surgical method of intrahepatic bile duct stone.Methods Retrospective analysis in May 1994 to May 2007 26 patients with intrahepatic bile duct stones,Implementation of the left liver resection in 6 cases,Hepatic left lateral lobectomy of 20 cases,Liver sections obtained,and the left hepatic duct stones joined forces with the common bile duct stones to take,correction of biliary stricture,The combined right hepatic duct stones were added with biliary-enteric anastomosis,With a T tube after 2-3 weeks of oral medicine.And conduct efficacy.Results 1 cases of elderly patients with tongue excision due to common bile duct duodenal anastomotic leakage occurred after the death,25 cases of discharged,T tube removal before the angiography showed no residual stone,Follow-up of 25 cases,18 cases the symptoms disappeared completely,6 cases with mild symptoms of cholangitis,gallbladder need to regularly take anti-inflammatory drugs;1 cases of bile duct stone recurrence after 5 years,Add as Roux-Y biliary-enteric anastomosis,the symptoms disappeared.Overall excellent rate of 98%.Conclusion The left hepatic lobe resection of intrahepatic bile duct stones satisfaction with long-term effects.