肝尾叶胆管结石的术中诊断与处理

目的 探讨肝尾叶胆管结石的术中诊断与手术处理方法。方法 回顾性总结19例尾叶胆管结石的诊疗经验。结果 全组均在术中明确诊断，右尾叶结石11例，左尾叶结石6例，双尾叶结石2例。合并左肝管结石2例，右肝管结石2例，左右肝管结石15例。10例合并尾叶胆管口狭窄者行尾叶胆管切开成形，肝胆管盆式Roux-en-Y吻合术；其余9例行左右肝管切开尾叶胆管取石，经胆总管T管或胆道气囊导管引流。无手术死亡，无并发症，术后15～18d经胆道造影，无结石残留，间歇夹管至术后21～28d后拔管。平均随访42．44（12～60）月，4例偶有腹痛，近远期疗效满意，无复发。结论 尾叶胆管结石术前易漏诊。术中诊查是发现尾叶胆管结石简便而有效的方法。充分显露、谨慎切开尾叶胆管口狭窄、取尽结石、通畅引流，是防止尾叶胆管结石残留的重要措施。

Intraoperative Diagnosis and Treatment of Intrahepatic Lithiasis in Caudate Lobe

Objective To investigate the diagnosis and treatment of intrahepatic lithiasis in caudate lobe. Methods 19 cases of intrahepatic lithiasis in caudate lobe were retrospectively reviewed. Results All cases were diagnosed as intrahepatic lithiasis of caudate lobe in operation, which involving right caudate lobe in 11 cases, left caudate lobe in 6 cases, total caudate lobe in 2 cases. Complicating left, right, and bilateral intrahepatic lithiasis were found in 2, 2, and 15 cases, respectively. Bile duct plasty and hepaticojejunostomy performed in 10 cases with stenosis bile duct.The rest 9 cases underwent bile ductal incision extended to right and left hepatic duct to expose caudate bile duct and remove the stones.The T tube removed at 21 to 28 days postoperatively with the exclusion of residual stones by cholangiography. There was no perioperative death, morbidity and recurrence according to 12 to 60 months follow-up(mean 42.44 months). Conclusion Caudate lobe lithiasis is tend to be misdiagnosed preoperatively. Intraoperative exploration is critical to identify the caudate lobe lithiasis. Adequate exposure, complete removal of stones, thorough drainage is essential to prevent the residual lithiasis.