中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
8期
641-643
,共3页
张宇华%胡智明%张成武%吴伟顶%刘杰%尚敏杰%金望迅%赵大建
張宇華%鬍智明%張成武%吳偉頂%劉傑%尚敏傑%金望迅%趙大建
장우화%호지명%장성무%오위정%류걸%상민걸%금망신%조대건
胆结石%肝切除术%入肝血流阻断
膽結石%肝切除術%入肝血流阻斷
담결석%간절제술%입간혈류조단
Cholelithiasis%Hepatectomy%Blockade,hepatic inflow
目的 探讨应用半肝入肝血流阻断行多处肝段切除治疗复杂肝内胆管结石的临床价值.方法 回顾性分析2004年1月至2010年10月应用半肝入肝血流阻断下行多处肝段切除治疗复杂肝内胆管结石12例患者的临床资料.结果 12例无死亡,肝脏切除范围(肝段):Ⅱ+Ⅲ+Ⅴ1例;Ⅱ+Ⅲ+Ⅵ2例;Ⅱ+Ⅲ+Ⅴ+Ⅵ1例;Ⅱ+Ⅲ+Ⅵ+Ⅶ4例;Ⅱ+Ⅲ+Ⅳ+Ⅵ3例;Ⅱ+Ⅲ+Ⅳ+Ⅵ+Ⅶ1例;术中平均出血(560±291)ml.术后出现切口感染2例(17%)、胆漏1例(8%)、腹腔感染1例(8%)、胸腔积液3例(25%).12例均无肝功能衰竭、腹腔出血或胆道出血.术后10d结石清除率为83%(10/12),术后6周结石清除率为92%(11/12),11例获得长期随访92%(11/12),中位随访时间为31个月,优良率达92%(11/12).结论 多处肝段切除治疗复杂肝胆管结石的近、远期效果好,入肝半肝血流阻断应用于多处肝段切除,增加了手术的安全性.
目的 探討應用半肝入肝血流阻斷行多處肝段切除治療複雜肝內膽管結石的臨床價值.方法 迴顧性分析2004年1月至2010年10月應用半肝入肝血流阻斷下行多處肝段切除治療複雜肝內膽管結石12例患者的臨床資料.結果 12例無死亡,肝髒切除範圍(肝段):Ⅱ+Ⅲ+Ⅴ1例;Ⅱ+Ⅲ+Ⅵ2例;Ⅱ+Ⅲ+Ⅴ+Ⅵ1例;Ⅱ+Ⅲ+Ⅵ+Ⅶ4例;Ⅱ+Ⅲ+Ⅳ+Ⅵ3例;Ⅱ+Ⅲ+Ⅳ+Ⅵ+Ⅶ1例;術中平均齣血(560±291)ml.術後齣現切口感染2例(17%)、膽漏1例(8%)、腹腔感染1例(8%)、胸腔積液3例(25%).12例均無肝功能衰竭、腹腔齣血或膽道齣血.術後10d結石清除率為83%(10/12),術後6週結石清除率為92%(11/12),11例穫得長期隨訪92%(11/12),中位隨訪時間為31箇月,優良率達92%(11/12).結論 多處肝段切除治療複雜肝膽管結石的近、遠期效果好,入肝半肝血流阻斷應用于多處肝段切除,增加瞭手術的安全性.
목적 탐토응용반간입간혈류조단행다처간단절제치료복잡간내담관결석적림상개치.방법 회고성분석2004년1월지2010년10월응용반간입간혈류조단하행다처간단절제치료복잡간내담관결석12례환자적림상자료.결과 12례무사망,간장절제범위(간단):Ⅱ+Ⅲ+Ⅴ1례;Ⅱ+Ⅲ+Ⅵ2례;Ⅱ+Ⅲ+Ⅴ+Ⅵ1례;Ⅱ+Ⅲ+Ⅵ+Ⅶ4례;Ⅱ+Ⅲ+Ⅳ+Ⅵ3례;Ⅱ+Ⅲ+Ⅳ+Ⅵ+Ⅶ1례;술중평균출혈(560±291)ml.술후출현절구감염2례(17%)、담루1례(8%)、복강감염1례(8%)、흉강적액3례(25%).12례균무간공능쇠갈、복강출혈혹담도출혈.술후10d결석청제솔위83%(10/12),술후6주결석청제솔위92%(11/12),11례획득장기수방92%(11/12),중위수방시간위31개월,우량솔체92%(11/12).결론 다처간단절제치료복잡간담관결석적근、원기효과호,입간반간혈류조단응용우다처간단절제,증가료수술적안전성.
Objective To evaluate the result of multiple segmentectomy under selective occlusion of hepatic inflow for complicated intrahepatic cholangiolithiasis. Methods In this study 12 cases of complicated intrahepatic cholangiolithiasis receiving multiple segmentectomy under selective occlusion of hepatic inflow during 2004. 1 - 2010. 10 were reviewed retrospectively. The short-term and long-term outcomes of the patients were analyzed. Results There was no surgical mortality in this group. The segmentectomy performed were Ⅱ + Ⅲ + Ⅴ in 1 case; Ⅱ + Ⅲ + Ⅵ in 2 cases; Ⅱ + Ⅲ + Ⅴ + Ⅵ in 1 case;Ⅱ +Ⅲ+Ⅵ +Ⅶ in4 cases; Ⅱ +Ⅲ +Ⅳ +Ⅵ in 3 cases and Ⅱ + Ⅲ +Ⅳ +Ⅵ +Ⅶ in 1 case. The average intraoperative blood loss was 560 ± 291 ml. Postoperative complications were wound infection in 2 cases, bile leakage in 1 case, abdominal infection in 1 case. There were no liver failure, intrabdominal hemorrhage or hemobilia; stone clearance rate at 10 days after operation was 83% (10/12) and 92%(11/12) at 6 weeks after operation following postoperative choledochoscopic lithotripsy. 92% (11/12) cases were followed-up with the median follow-up period of 31 months. The result was excellent or good in 92% (11/12) cases. Conclusions Multiple segmentectomy was the choice for complicated intrahepatic cholangiolithasis, and the procedure could be safely performed under selective occlusion of the hepatic inflow.
