CAJ | 학술논문

目的探讨经Glisson鞘美蓝染色解剖性肝切除治疗右肝后叶胆管结石的有效性及技术要点.方法回顾性分析收治的12例经Glisson鞘美蓝染色解剖性肝切除治疗右肝后叶胆管结石的临床资料.结果 12例患者中,6例为2次以上胆道手术者.全部患者均行肝CT增强扫描及门静脉成像,单纯右肝Ⅵ段胆管结石4例,右肝后叶胆管结石8例,伴左肝外侧叶胆管结石2例、右侧尾状叶胆管结石1例.分离肝Ⅵ段或右肝后叶Glisson鞘,经门静脉注入美蓝,肝Ⅵ或右肝后叶美蓝界面显示良好.美蓝界面比缺血界面大且符合解剖.沿美蓝界面Ⅵ、Ⅶ段联合切除9例,Ⅵ段切除3例,合并左肝外侧叶切除2例、右侧尾状叶切除1例.术后切口感染5例、右胸腔积液4例、胆瘘2例,均保守治疗后痊愈,术后无死亡病例.所有患者获得3个月至7年(平均3.2年)随防,无结石复发.结论经Glisson鞘美蓝染色解剖性肝切除是右肝后叶胆管结石安全而有效的治疗措施.熟悉Glisson鞘的解剖和紧贴Glisson鞘分离是避免损伤胆管或门静脉的有效办法.
목적 탐토경Glisson초미람염색해부성간절제치료우간후협담관결석적유효성급기술요점.방법 회고성분석수치적12례경Glisson초미람염색해부성간절제치료우간후협담관결석적림상자료.결과 12례환자중,6례위2차이상담도수술자.전부환자균행간CT증강소묘급문정맥성상,단순우간Ⅵ단담관결석4례,우간후협담관결석8례,반좌간외측협담관결석2례、우측미상협담관결석1례.분리간Ⅵ단혹우간후협Glisson초,경문정맥주입미람,간Ⅵ혹우간후협미람계면현시량호.미람계면비결혈계면대차부합해부.연미람계면Ⅵ、Ⅶ단연합절제9례,Ⅵ단절제3례,합병좌간외측협절제2례、우측미상협절제1례.술후절구감염5례、우흉강적액4례、담루2례,균보수치료후전유,술후무사망병례.소유환자획득3개월지7년(평균3.2년)수방,무결석복발.결론 경Glisson초미람염색해부성간절제시우간후협담관결석안전이유효적치료조시.숙실Glisson초적해부화긴첩Glisson초분리시피면손상담관혹문정맥적유효판법.
Objective To investigate the effectiveness and technical points of anatomical liver resection by trans-Glisson Sheath methylene blue staining in treatment of hepatolithiasis of right posterior lobe.Methods The clinical data of 12 cases of hepatolithiasis of right posterior lobe treated with anatomical liver resection by Glisson sheath methylene blue staining were retrospectively analyzed.Result 6 of 12 patients had undergone more than 2 previous biliary surgeries.All patients underwent contrast-enhanced CT scan and portography,hepatolithiasis of segment Ⅵ in 4 cases,right posterior lobe in 8 cases,accompanied by left lateral lobe bile duct stones in 2 cases,the right caudate lobe bile duct stones in 1 case.Methylene blue was injected into the portal vein,the methylene blue interface of segment Ⅵ or right posterior lobe displays well.Methylene blue interface was larger than the ischemia interface,which is in accordance with the anatomy.Along the methylene blue interface,hepatic resection was performed including right posterior lobe resection (n =9),segment Ⅵ resection (n =3),and combined with left lateral lobe resection (n =2) and the right caudate lobe resection (n =1).There was no postoperative mortality.Incision infection occurred in 5 cases,4 had right pleural effusion and 2 had a biliary fistula that were treated conservatively.With a mean follow-up period of 3.2 years,all patients are symptoms free and stone free.Conclusions Anatomical liver resection by methylene blue staining is a safe and effective treatment for hepatolithiasis of right posterior lobe.