目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
Objective To investigate the recurrence of intrahepatic bile duct stones and study the relations to the primary intrahepatic stones.Methods One hundred and twenty nine patients who experienced complete lithotomy were followed up for 2-10 years. Results Thirty five cases had the recurrence of intrahepatic stones at 49 sites (27.13%). The recurrent stones were found at following sites: 13 at left duct, 12 right duct , 8 left medial segment, 6 right anterior segment, 4 right posterior segment, 3 left lateral segment, 3 caudate. Nine cases were asymptomic, 16 cases had slight symptoms and 10 cases suffered from the serious attacks of stones. The time of recurrence was from 2 to 9 years (5.49±2.25 years) after surgery. The recurrent rate was 27.13% in our group. Conclusion The recurrence of intrahepatic stones also developed at several sites in the liver. The recurrence of intrahepatic stones had a tendency to develop at the primary sites. The recurrence of intrahepatic stones may be asymptomic and most patients suffered from slight attack. Liver resection is the best way to prevent the recurrence from intrahepatic stones.
In 1983-1994,748 cases hepatocholelithiasis had been treated in our department, in which 372 patients underwent hepatectomy and 43 patients underwent hepatectomy of the quadrate lobe. Hepatectomy of the quadrate lobe has been performed to treat all kinds of hepatocholelithiasis, it is easy to expose 1 or 2 degree branch of biliary tree, incise the hepatobiliary stricture and perform hepatocholangiojejunostomy in the hepatic hilum.
ObjectiveTo investigate the feasibility and safety of subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.MethodThe clinicopathologic data of patient with hepatolithiasis whose left and right hepatic lobe atrophied and caudate lobe obviously hypertrophied admitted to the West China Hospital of Sichuan University in February 2020 were analyzed retrospectively.ResultsThe patient was in good general condition before the operation. The cardiopulmonary and kidney functions were normal. The liver function was Child-Pugh A grade, and the liver reserve function was good. The body surface area of the patient was 1.745 m2 and the standard liver volume was 1 235 mL. The volume of caudate lobe calculated by the 3D reconstruction of CT image was 735 mL, accounted for 59.5% of the standard liver volume. The patient was evaluated to be able to tolerate the operation. The patient successfully experienced the operation of subtotal hepatectomy with caudate lobe preservation. The postoperative liver function recovered well. The gastric tube was removed on the 4th day after the operation. The peritoneal drainage tube was removed on the 5th day after the operation. The patient was discharged on the 6th day after the operation. The postoperative pathological diagnosis: The intrahepatic bile duct was dilated with stones inside. A large number of inflammatory cell infiltrated around the bile duct. The fibrous tissue hyperplasia, small bile duct hyperplasia and inflammatory cell infiltration were observed in the portal area. The pathological changes were consistent with the changes of hepatolithiasis.ConclusionAccording to analysis results of this case, subtotal hepatectomy with preservation of caudate lobe is safe and feasible for hepatolithiasis patient with obvious atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.
Objective To observe the effect of gefitinib on expression of epidermal growth factor receptor (EGFR) in bile duct epithelial cells, and the feasibility of inhibiting hyperplasia of bile duct epithelial cells with gefitinib. Methods Sixty-one patients with hepatolithiasis having to be in hospital for surgery from the First People’s Hospital of Shuangliu county were selected, with 25-65 years old, average 46.92 years. The patients were randomly divided into therapy group and control group. There were 30 cases in therapy group, in which fine duct was placed on lesion bile duct during operation, and through whom gefitinib solution was perfused after operation. There were 31 cases in control group with only T tube drainage after operation. The bile duct sample was obtained respectively during the operation and 6 weeks and 12 weeks after operation. The histology and expression change of EGFR were observed by HE staining, immunohistochemistry and RT-PCR method respectively. Results There were no significant differences in pathohistology changes of bile duct and the EGFR protein and mRNA expression between therapy group and control group during operation. The hyperplasia of epithelium mucosae and submucosal gland in the therapy group were obviously decreased as compared with those in control group, the EGFR mRNA and protein expression in therapy group were weaker than those of control group （Plt;0.05） 6 weeks and 12 weeks after gefitinib treatment. Conclusion EGFR is overexpressed in the chronic proliferative cholangitis, and continuously local application of gefitinib after operation can specifically interrupt the activation and expression of EFGR and then effectively inhibit the hyperplasia of bile duct epithelial cells.
近年来，胆石症的发病谱已发生了根本性的变迁，一些大城市的胆囊结石发病率逐步增加，过去常见的肝内胆管结石已明显减少； 但多数地区肝内胆管结石发病率仍较高，仍是我国的常见病之一，其治疗也仍是胆道外科中的困难问题。运用现代肝脏外科手术技术，处理肝门部和肝内胆管及血管，获得良好的显露，基本上可达到“解除梗阻，去除病灶，通畅引流”的肝胆管结石外科治疗原则。由于肝内胆管结石本身的复杂性，目前尚无一种手术方式可使所有患者获得满意效果，因此，应根据患者的实际情况采用“个体化治疗方案”。常用的手术方法有胆管探查取石、胆肠引流、肝叶切除术等。根据病情、患者的身体素质、技术条件和病变的性质等综合考虑来决定术式。
目的探讨肝内胆管结石合并肝胆管癌的临床诊断和治疗经验。 方法回顾性分析我院手术治疗28例肝内胆管结石合并肝胆管癌的病例资料。结果本组28例占同期肝内胆管结石病例的6.7%。术前各类影像学检查发现癌灶17例，5例获细胞学检查确诊。术中7例经快速组织活检证实。另4例系术后确诊。肿瘤多为腺癌，位于肝门胆管18例，肝内胆管9例，肝内、肝门部广泛浸润1例。根治性肿瘤切除8例，获随访6例，平均生存23个月； 姑息性肿瘤切除8例，获随访6例，平均生存11个月； 仅行外引流者7例，其中3例于术后2周内死亡，3例术后9个月内死亡，1例生存4个月后失访。结论长期肝内胆管结石刺激及继发感染是肝胆管癌发生的重要因素。联合应用影像学检查结合病理活检获得早期诊断和选择合理的根治性肝切除术是提高疗效的有效措施。