中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 9
Sep.  2016
Turn off MathJax
Article Contents

Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy

DOI: 10.3969/j.issn.1001-5256.2016.09.025
  • Published Date: 2016-09-20
  • Objective To investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December,2013. The distribution characteristics of intrahepatic bile duct stones,clinical manifestations,extent of operation,time of operation,complications,and surgical outcome were analyzed. Results All the 98 patients completed regular hepatectomy. Of all patients,37 underwent choledocholithotomy with T- tube drainage and segmental hepatectomy,6 underwent resection of the left lateral lobe of the liver,1 underwent left hemihepatectomy,7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy,45 underwent combined segmental hepatectomy of the left and right lobes of the liver,and 2 underwent biliary- enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65. 0 ± 5. 0 min,and the mean intraoperative blood loss was 83. 0 ± 6. 2 ml. No patients experienced residual stones after surgery. Of all patients,5( 5. 1%) experienced complications,among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years,and 11( 11. 2%) experienced recurrence of stones after surgery. Conclusion Regular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones,with few complications and a low recurrence rate of stones. Therefore,it holds promise for wide clinical application.

     

  • loading
  • [1]SUN Q,CHANG XJ,HU ZM,et al.Laparoscopic anatomical hepatectomy combined with choledochoscopy for hepatolithiasis[J].J Hepatopancreatobiliary Surg,2014,26(6):447-450.(in Chinese)孙强,常晓健,胡泽民,等.腹腔镜下规则性肝切除术联合胆道镜治疗肝内外胆管结石[J].肝胆胰外科杂志,2014,26(6):447-450.
    [2]CHEN YJ,CAI XY,LU BY,et al.Clinical effect of laparoscopic left hepatectomy combined with choledochoscopy in treatment of intrahepatic bile duct stones[J].Guangdong Med J,2014,35(2):241-243.(in Chinese)陈永军,蔡小勇,卢榜裕,等.腹腔镜左肝切除联合胆道镜治疗肝内胆管结石的效果[J].广东医学,2014,35(2):241-243.
    [3]ZHU WD,TAN XG,DENG RG,et al.Clinical application of precise hepatectomy techniques in right intrahepatic bile duct stones[J].Clin J Curr Adv Gen Surg,2013,16(6):451-454.(in Chinese)朱卫东,谭兴国,邓如岗,等.精准肝切除技术在治疗右侧肝胆管结石中的应用[J].中国现代普通外科进展,2013,16(6):451-454.
    [4]ZHUANG ZH,YU XF,ZHENG JF,et al.Outcome of different operative procedures for the intrahepatic lithiasis in 167 cases[J].J Hepatopancreatobiliary Surg,2013,25(2):100-102.(in Chinese)庄哲宏,余小舫,郑锦锋,等.肝内胆管结石167例手术疗效分析[J].肝胆胰外科杂志,2013,25(2):100-102.
    [5]COPELAN A,KAPOOR BS.Choledocholithiasis:diagnosis and management[J].Tech Vasc Interv Radiol,2015,18(4):244-255.
    [6]INOKO K,TSUCHIKAWA T,NOJI T,et al.Hilar cholangiocarcinoma with intratumoral calcification:a case report[J].World J Gastroenterol,2015,21(38):10926-10930.
    [7]CHEN WQ,HE YZ,LI JP,et al.Laparoscopic anatomic left hemihepatectomy plus choledochoscopic lithotomy for concomitant intraand extrahepatic bile duct stones[J].Chin J Gen Surg,2014,23(8):1034-1037.(in Chinese)陈武强,何友钊,李建平,等.腹腔镜规则性左半肝切除联合胆道镜取石治疗肝内外胆管结石[J].中国普通外科杂志,2014,23(8):1034-1037.
    [8]ZHANG XY.The efficacy analysis of anatomical and non-anatomical hepatic lobectomy in 100 patients with hepatolithiasis[J].Chin J Gen Surg,2015,24(7):1050-1053.(in Chinese)张献毅.规则和非规则性肝叶切除术治疗肝胆管结石病患者的效果分析[J].中国普通外科杂志,2015,24(7):1050-1053.
    [9]LU DB,LI QL.Application study of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones[J].J Hanan Med Coll,2016,22(6):562-564,567.(in Chinese)鲁德斌,李乔林.规则性肝切除并胆管镜在肝内胆管结石治疗中的应用研究[J].海南医学院学报,2016,22(6):562-564,567.
    [10]CAO L,LI JW,CHEN J,et al.Analysis of 35 cases of roboticassisted laparoscopic liver resection[J].Pract J Clin Med,2015,12(1):19-21,22.(in Chinese)曹利,李建伟,陈健,等.机器人辅助腹腔镜肝切除35例分析[J].实用医院临床杂志,2015,12(1):19-21,22.
    [11]TANG XD,LIU SH,JIANG J,et al.Different methods of laparoscopic common bile duct exploration for extrahepatic bile duct stones[J].Chin J Hepatobiliary Surg,2013,19(8):589-592.(in Chinese)汤晓东,刘双海,蒋剑,等.不同方式腹腔镜胆道探查术治疗肝外胆管结石的临床研究[J].中华肝胆外科杂志,2013,19(8):589-592.
    [12]LUO KL,FANG Z,YU F,et al.Laparoscopic cholecystectomy and laparoscopic transcystic common bile duct exploration using a mini incision and primary suturing of the bile duct in the treatment of gallbladder and common bile duct stones[J].Chin J Hepatobiliary Surg,2013,19(5):349-351.(in Chinese)罗昆仑,方征,余锋,等.腹腔镜经胆囊管开口微切开胆管并一期缝合胆管治疗胆囊结石合并胆管结石[J].中华肝胆外科杂志,2013,19(5):349-351.
    [13]YANG Q,ZHOU Y,LI FY,et al.Effects of epidermal growth factor receptor inhibitor on proliferative cholangitis in hepatolithiasis[J].Hepatobiliary Pancreat Dis Int,2015,14(5):509-515.
    [14]WANG XP,LUO XR,HUANG HY,et al.Causes of postoperative mental disorders in patients with bile duct stones and related nursing skills[J].J Nurs Training,2013,28(14):1322-1324.(in Chinese)汪小平,罗秀荣,黄海英,等.胆管结石患者术后精神障碍原因分析及护理[J].护士进修杂志,2013,28(14):1322-1324.
    [15]ZHANG R,LUO H,PAN Y,et al.Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones:evidence from barium meal examination[J].Gastrointest Endosc,2015,82(4):660-665.
    [16]KONG J,WU SD.Comprehensive review of strategies for diagnosis and treatment of hepatolithiasis[J].J Clin Hepatol,2013,29(3):163-165.(in Chinese)孔静,吴硕东.肝内外胆管结石的综合诊断与治疗[J].临床肝胆病杂志,2013,29(3):163-165.
    [17]CHEN Y,YU XF,BAO SY,et al.MRI to compare the long-term outcomes of partial hepatectomy versus choledocholithotomy in the treatment of hepatolithiasis[J].Chin J Hepatobiliary Surg,2015,21(7):442-444.(in Chinese)陈阳,余小舫,鲍世韵,等.磁共振对比肝切除与胆总管切开取石术治疗肝胆管结石的远期疗效[J].中华肝胆外科杂志,2015,21(7):442-444.
    [18]LYU WP.Clinical classification of hepatolithiasis and choice of surgical strategy[J].J Clin Hepatol,2013,29(6):404-406.(in Chinese)吕文平.肝胆管结石病的临床分型与手术方式选择[J].临床肝胆病杂志,2013,29(6):404-406.
    [19]TEJERA HERNNDEZ AA,CABRERA GARCIA ME,NAVARRO MEDINA P,et al.Hepatolithiasis.Surgical approach using endoscopic holmium laser for treatment[J].Gastroenterol Hepatol,2016.[Epub ahead of print]
    [20]FU N,LUO DY.The application research of the regular hepatectomy treating the complicated intrahepatic cholangiolithiasis[J].J Chengdu Med Coll,2014,9(6):722-724.(in Chinese)付宁,罗道蕴.规则肝切除在复杂肝内胆管结石治疗中的应用研究[J].成都医学院学报,2014,9(6):722-724.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2284) PDF downloads(460) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return