肝胆管结石病外科治疗方法疗效的临床研究
Clinical study on curative effect of surgical treatment for hepatolithiasis
李小归 1吴意 1卢嘉胤 1李浩 1汪新天1
作者信息
- 1. 湖南师范大学附属第一医院 胆道外二科/湖南省卫生健康委员会胆道疾病研究中心,长沙 410005
- 折叠
摘要
目的:探讨肝胆管结石的外科治疗方式及疗效.方法:回顾性分析2019年1月―2022年7月湖南省人民医院肝胆外科外科手术诊治的658例肝胆管结石患者的病例资料,并对病例的特点以及所行术式进行分析.结果:658例中行肝叶切除306例(46.50%),其中腹腔镜肝叶切除有90例(13.7%);胆肠内引流345例(52.58%);钬激光使用304(46.20%);行经皮肝胆管穿刺碎石术(percutaneous transhepatic choledochoscopic lithotripsy,PTCSL)44例(6.69%).全组死亡病例2人,196例(29.79%)术后复查CT发现残石,其中63例(9.57%)后行胆道镜取石.术后发生复杂胆道感染19例(2.89%),其中2例(0.31%)因重症感染导致多器官功能衰竭后死亡,其余17例((2.58%)予反复胆汁培养调整抗生素等对症支持治疗后好转.术后胆漏52例(7.90%),均经营养支持治疗或超声引导下腹腔置管引流后胆漏自限.术后出血50例(7.60%),其中4例(0.61%)再开腹探查止血,3例(0.46%)介入栓塞止血,其余经保守治疗后出血停止.结论:肝胆管结石病情复杂个体差异化大,需要多科室协作,联合采用多种先进技术,针对具体病例制订"个体化"治疗方案.
Abstract
Objective To investigate the surgical treatment of hepatolithiasis.Methods Retrospective analysis and sum-mary were made of 658 cases of hepatolithiasis treated by our department of surgery from January 2019 to July 2022,and the characteristics of the cases and surgical methods were analyzed.Results Among the 658 cases,306 cases(46.50%)underwent hepatic lobectomy,among which laparoscopic hepatic lobectomy accounted for 13.7%;biliary and intestinal drainage ac-counted for 52.58%;holmium laser accounted for 46.20%;percutaneous hepatic bile duct lithotripsy(percutaneous transhepatic choledochoscopic lithotripsy(PTCSL)accounted for 6.69%.There was 1 death in the whole group,and 196 patients(29.79%)were found to have residual stones in postoperative CT scans,of which 63 patients(9.57%)underwent choledochoscopy for stone removal.19cases(2.89%)of complicated biliary tract infection occurred after operation,of which 2 case(0.31%)died after multiple organ failure due to severe infection,and the remaining 17 cases((2.58%)were treated with repeated bile culture to adjust antibiotics and other symptomatic cases improved after supportive treatment.There were 52 cases(7.90%)of postopera-tive bile leakage,all of which were self-limited after nutritional support therapy or ultrasound-guided intraperitoneal drainage.There were 50 cases(7.60%)of postoperative hemorrhage,of which 4 cases(0.61%)underwent laparotomy for hemostasis,3 cases(0.46%)underwent interventional embolization for hemostasis,and the rest stopped bleeding after conservative treatment.Conclusion The disease of hepatolithiasis is complicated and personalized,which requires multi-departmental collaboration and combination of a variety of advanced technologies to formulate"individual"treatment plan for specific cases.
关键词
肝胆管结石/治疗方案/微创手术Key words
hepatolithiasis/treatment options/microtrauma operation引用本文复制引用
出版年
2024
NETL
NSTL
万方数据