肝内外胆管多发结石肝部分切除术后肝功能衰竭的诊治

目的：探讨肝内外胆管多发结石术后肝功能衰竭的预防、诊断及治疗。方法：我院2011年1 月~2013 年12 月收治肝内外胆管多发结石行手术治疗患者共126 例，术后发生肝功能衰竭者6 例，均是合并肝叶切除患者。及时准确诊断肝功能衰竭后予抗炎、护肝、止血、输血、糖皮质激素、抑酸、人血白蛋白、利尿、降血氨、血浆置换及对症支持等治疗。结果：6 例患者出院前复查总胆红素28.3~ 58.7 mmol/L，谷丙转氨酶16~ 62 U/L，谷草转氨酶12~ 85 U/L，血浆白蛋白32.1~ 37.8 g/L，凝血功能基本正常，腹水消失，血氨正常，上消化道出血停止。术后12~ 35 d出院，平均18 d。6例患者术后长期随访，目前均存活。结论：肝功能衰竭是肝脏及胆道术后最为严重的并发症之一，充分的术前准备及评估，术后的及时诊断及治疗，可明显降低其死亡率。

The Diagnosis and Treatment of Liver Failure after Hepatectomy of Bile DuctStones

Objective:To explore the prevention, diagnosis and treatment of postoperative liver failure of the multiple stones ofbile duct.Methods:FromJanuary 2011 to December 2013, a total of 126 patients with multiple stones of bile duct of liver inside and outsidelines who underwent surgical treatment were hospitalized, postoperative liver failure were found in 6 cases who received merger loberesection, accounted for 4.76%. After timely and accurate diagnosis of liver failure, the anti-inflammation protection of liver, hemostasis,human blood albumin, glucocorticoid, inhibition of gastric acid, blood transfusion, diuresis, fall blood ammonia, plasma exchange, symptomatictreatment and support treatment were given to the patients.Results:Before discharging fromhospital, the T-BIL of 6 patients was28.3 ~ 58.7 mmol/L. ALT was 16 ~ 62 U/L, AST was 12 ~ 85 U/L, plasma albumin was 32.1 ~ 37.8 g/L, the coagulation function returnedto normal, the ascites disappeared, blood ammonia was normal, upper gastrointestinal bleeding was stopped. Post operative hospitalizationduration 12 ~ 35 d, an average of 18 days. All 6 patients survived in the follow-up, visit until now.Conclusion:Liver failurewas one of the most serious complications of liver and biliary tract surgery, however, sufficient preoperative preparation and evaluation,timely preoperative diagnosis and treatment, could obviously reduce the mortality.