肝胆管盆式内引流治疗肝内胆管多发结石74例体会(一)

详细内容

作者：谢楚平 陈宇辉 吴泽建

【关键词】 肝胆管

摘要：目的：分析74例肝内1～3级胆管多发结石的盆式内引流方法、适应征及临床价值。方法：病例均行胆囊功除，胆总管、肝总管肝内1～3级胆管切开，解除狭窄环，取尽结石，胆管成型为盆状，与空肠Roux-en-y吻合。结果：所有病例皆解除狭窄，取尽结石，畅通胆汁，并可防止返流。结论：肝胆管盆式吻合术，不但能取尽肝内胆管结石，并能解除狭窄，又能通畅引流，还能避免结石的残留和复发，是目前能治疗肝胆结石并狭窄比较理想的术式，值得推广。

关键词：肝胆管盆式引流；胆肠吻合术；肝内胆管结石

eva luation the Treatment of 74 Cases Intracholdocholithiasis with Hepatobiliary- basin Drainage

Abstract： Objective： To analyze methods indications and clinical value of hepatobiliary-basin drainage in treatment of 74 cases intracholedocholithiasis. Method： All patients underwent open cholecystectomy .mon bile duct was exposed and excided after cholecystectomy was pleted ,The stones were extracted from mon bile duct .Stenosis of mon duct was removed and was unobstructed,No stenosis existed in intrahepatic duct and preformed roux-en-y anastomosis. Results： All patients removed stenosis of bile duct , The stones were extracted from mon bile duct, mon bile duct was unobstructed.Conclusion： Hepatobiliary-basin drainage can extract the stone and remove stenosis. It is one of the safe and effective management options for mon bile duct calculi and stenosis of bile duct.We advocated it in appropriate cases

Key words:Hepatobiliary-basin drainage；Roux-en-y anastomosis；Intraholedocholithiasis

肝内胆管结石常并有肝胆管狭窄和肝内感染，是胆道外科中最复杂辣手的课题之一。其手术治疗的公认原则是：取净结石、解除梗阻，去除病灶，通畅引流。我科自1993年5月至2002年7月采用切开肝内1～3级胆管，胆管盆式成型，与空肠Roux-en-y吻合内引流的方式治疗肝内胆管多发性结石并狭窄病人74例，取得了满意的效果，报道如下：

1资料与方法

1.1一般资料：男14例，女60例，年龄24～71岁，平均年龄44.8岁。术前经B超、CT、MR 、PTC检查确诊，术中探查证实。结石分布：胆总管并左右肝内多支胆管充满型结石19例（含尾状叶胆管），胆总管并左外叶胆管12例，左右肝管并右前叶下段支21例，左右肝管并右后叶上段支16例，左右肝管并尾状叶胆管6例。

1.2手术方法

1.2.1手术适应征：肝内外胆管结石合并高位胆管狭窄者；肝内胆管铸型结石非直视下不能取出者，弥漫性肝内泥沙型结石；肝内残留或复发胆管性结石伴肝外胆管扩张，胆管壁增厚，胆管炎反复发作者；肝内外胆管结石伴胆管扩张胆总管远端狭窄者。

1.2.2手术方式：以上病例均行胆囊功除，胆总管、肝总管肝内1～3级胆管切开，解除狭窄环，取尽结石，胆管成型为盆状，与空肠Roux-en-y吻合（其中两例行肝左外侧叶切除）。取出结石最多的达150g，均为胆色素性结石，及混合性结石。