皮下盲袢型胆肠吻合术与肝切除治疗肝内胆管结石并狭窄临床分析.DOCVIP

临床医学论文-皮下盲袢型胆肠吻合术与肝切除治疗肝内胆管结石并狭窄临床分析 ?????????? 作者：邱爱华，夏卉芳，夏永兴 ?? 【摘要】? 目的? 用术式改进法提高肝内胆管结石的疗效。方法? 32例肝内胆管结石均接受皮下盲袢型胆肠吻合术，其中结石位于右肝7例（22%），左肝9例（28%），两肝均有16例（50%）；结石合并肝胆管狭窄24例（75%），全部病例均切开胆总管上部、肝总管、左右肝管，并切开肝内胆管狭窄部以上1cm肝管，将切开的胆管做必要的缝合，形成碟状，取一段空肠上提，盲袢埋置皮下，再做胆肠Roux-en-Y吻合，病肝做规则性肝部分切除术。结果? 26例得到随访，随访率81%，随访1～10年，平均6年，发生率19%，其中14例经皮下盲袢穿刺冲洗引流治疗，12例穿刺胆管造影，6例经皮下盲袢切开引流，胆镜取石共8例次。结论? 肝叶切除术降低了肝胆管结石残留和结石复发率。皮下盲袢这一永久通道，可穿刺盲袢胆道造影、冲洗、引流，还可经过皮肤空肠小切口胆镜取石，扩张解除肝胆管狭窄，最大限度减少患者手术痛苦。 ??? 【关键词】? 胆管结石；肝脏；胆肠吻合术 ??? Subcutaneousnonport hepatoenterostomy and liver excision in treatment of hepatolith ???? 【Abstract】? Objective? To improve the therapeutic effect of the hepatolith treatment by bettering the surgical fashion.Methods? 32 patients have received the subcutaneous-non-port hepatoenterostomy.There are 7 patients of right liver （the percent is 22）,9 patients of left part （the percent is 28） and 16 patients of both parts （the percent is 50）.Firstly,all patients have been excided the upper ductus choledochus,the liver gross duct,left right liver duct besides one centimeter of liver duct that lies upwards the hepatolith.Secondly, we have sutured the excided bile duct,which has been shaped acetabuliform,lifted one part of jejunums,intered non-port one subcuneously,and then inosculated gall with enteron by Roux-en-Y way.Lastly,we have partly excised the ill liver in regular way.Results? 26 ones have been follow-up for 1～10 years.The rate is 81 percents,average for 6 years.There are 8 ones remain or recure.The rate is 25 percents.There are 6 cholangitiths.The rate is 19 percents.We have cured 6 patients with puncturing subcutaneous-non port intestine and cured 8 patients by extracting calculus with gall-endoscope.Conclusion?Liver-excision has decreased the calculus抯 recursion rate and remnant rate.Subcutaneous-non-port one can be used not only by puncturing,draining and washing,but also by extracting concretions,expanding,and relieving straitness.in the way,we can relieve patinet抯 reoperational