CAJ | 학술논문

目的探讨肝囊型包虫病内囊摘除术后顽固性残腔胆瘘的治疗方法.方法回顾性分析于2002年6月至2012年6月因肝囊型包虫术后胆瘘长期不愈就诊于新疆医科大学第一附属医院行手术治疗的31例患者.其中15例行T管引流+瘘口缝合+腹腔引流术,8例行经胆漏口置入T管+腹腔引流术,4例行半肝切除术,2例行肝叶切除+胆肠吻合术,1例行外囊剥离术,1例因腹腔感染严重行残腔脓肿清除术,半年后行半肝切除术.结果随访1～8年,1例患者T管引流术2年后出现胆管狭窄,行胆肠吻合术治愈;1例患者T管引流术后再次出现残腔胆漏,给予充分引流后1个月后自闭;1例患者残腔脓肿清除术后再次出现残腔胆漏,经充分引流半年后行半肝切除术,术后恢复顺利;1例半肝切除术后出现创面胆漏,经充分引流后治愈;其余患者术后恢复良好.结论 (1)肝切除术及肝包虫外囊完整剥离术因完整去除残腔可彻底解决残腔顽固性胆瘘,但此类患者多为多次手术后且残腔反复继发感染而致手术难度及风险较大;(2)经胆管注射美蓝行胆管造影及减压术,探查包虫残腔壁与胆道的漏口,并进行准确的缝闭,可彻底解决术后残腔胆漏的问题,而留置减压管则对漏口的愈合、防止漏口再次裂开形成胆漏具有一定作用;(3)针对包虫残腔与主肝管相通,且瘘口周残腔壁钙化严重,于残腔胆瘘口内置入合适T管,可有效解决残腔胆瘘.
목적 탐토간낭형포충병내낭적제술후완고성잔강담루적치료방법.방법 회고성분석우2002년6월지2012년6월인간낭형포충술후담루장기불유취진우신강의과대학제일부속의원행수술치료적31례환자.기중15례행T관인류+루구봉합+복강인류술,8례행경담루구치입T관+복강인류술,4례행반간절제술,2례행간협절제+담장문합술,1례행외낭박리술,1례인복강감염엄중행잔강농종청제술,반년후행반간절제술.결과 수방1～8년,1례환자T관인류술2년후출현담관협착,행담장문합술치유;1례환자T관인류술후재차출현잔강담루,급여충분인류후1개월후자폐;1례환자잔강농종청제술후재차출현잔강담루,경충분인류반년후행반간절제술,술후회복순리;1례반간절제술후출현창면담루,경충분인류후치유;기여환자술후회복량호.결론 (1)간절제술급간포충외낭완정박리술인완정거제잔강가철저해결잔강완고성담루,단차류환자다위다차수술후차잔강반복계발감염이치수술난도급풍험교대;(2)경담관주사미람행담관조영급감압술,탐사포충잔강벽여담도적루구,병진행준학적봉폐,가철저해결술후잔강담루적문제,이류치감압관칙대루구적유합、방지루구재차렬개형성담루구유일정작용;(3)침대포충잔강여주간관상통,차루구주잔강벽개화엄중,우잔강담루구내치입합괄T관,가유효해결잔강담루.
Objective To explore the efficacy of various managements of indurative biliary fistula after HCE operation.Methods 31 patients who underwent surgery for indurative biliary fistula after HCE operation in Xinjiang Medical University were studied retrospectively.Cholangiography and common bile duct exploration through a T tube were done in 15 patients,cholangiography and decompression through a T tube which led to the orifice of the fistula of the cavity in 8 patients,hepatectomy in 4 patients,lobe resection + choledochojejunostomy in 2 patients,total pericystectomy in 1 patient,and cavity abscess debridement in 1 patient for severe infection of the abdominal cavity,followed by hemihepatectomy after half a year.Result On follow-up of 1-8 years,choledochojejunostomy had to be done in 1 patient for stricture of the bile duct after T tube drainage,hepatectomy in 1 patient for bile leakage after the cavity abscess debridement operation,and bile leakage in 1 patient after hepatectomy although with drainage the patient was cured.Conclusion The results suggested that hepatectomy and total pericystectomy completely solved the problems arising from indurative biliary fistula.However,these procedures are complicated,and have higher operative risks.Cholangiography and common bile duct exploration solved the cavity-related problems.For patients with severe calcified cavities which communicated with large hepatic ducts,cholangiography and decompression through a T tube put into the orifice of the fistula of the cavity solved the indurative biliary fistula efficaciously and safely.