Surgical treatment of cholangiolithiasis with cavernous transformation of the portal vein: a review and analysis of 18 cases
摘要: 目的分析胆管结石合并门静脉海绵样变性(CTPV)的临床特点,探讨治疗方式。方法回顾性分析2009年1月至2012年12月本院收治的胆管结石合并CTPV患者18例的临床资料,包括治疗方法、手术方法、手术时间、术中出血量、并发症、结石清除率等。结果本组病例中无死亡病例。行经内镜逆行胰胆管造影(ERCP)者8例,经肝门途径取石者3例,手术时间2.9~5.4 h(平均3.8 h),术中出血量150~2630 ml(平均430 ml),术后结石残余率为11%。结论对于合并慢性肝病病史、多次胆道手术病史尤其是合并多次胆道感染患者,须警惕是否合并CTPV,术前依据影像学资料、肝功能及患者一般情况等制定个体化治疗方案,术中利用胆道镜尽量取尽结石,必要时利用超声协助行肝叶切除以去除肝内胆管结石。Abstract: Objective To analyze the clinical features of cholangiolithiasis with cavernous transformation of the portal vein ( CTPV) and to investigate the surgical treatment of this disease. Methods A retrospective analysis was performed on the clinical data of 18 patients with cholangiolithiasis with CTPV who were admitted to our hospital from January 2009 to December 2012; the clinical data included treatment method, surgical approach, time of operation, blood loss during operation, complications, and stone clearance rate. Results No death was seen in these cases. Eight cases underwent endoscopic retrograde cholangiopancreatography, and 3 cases underwent stone removal through the porta hepatis. The time of operation was 2. 9- 5. 4 h ( mean, 3. 8 h) . The blood loss during operation was 150- 2630 ml ( mean, 430 ml) . The rate of residual stones was 11%. Conclusion For patients with cholangiolithiasis who have a history of chronic liver diseases and who have undergone biliary tract surgery several times, especially those with recurrent biliary tract infection, examination should be carried out to detect CTPV, and individualized therapy should be determined before operation according to imaging data, liver function, and general condition. It is better to remove all stones using a choledochoscope during operation, and ultrasound- assisted hepalobectomy can be performed if necessary to remove intrahepatic stones.
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