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1、2o14年4月第29卷第4期ChinJGenSurg，April2014．V0I_29．N0．4·289·．論著．左、右肝管低位匯合的診斷與臨床意義朱志楊任培土【摘要】目的探討左、右(后支)肝管低位匯合的臨床意義。方法回顧性分析浙江省紹興市人民醫(yī)院自2000年1月至2013年6月問收治的12例左、右(后支)肝管低位匯合患者的臨床資料。結(jié)果本組12例患者肝管匯合點距肝門2cm至十二指腸上緣之間8例，低于十二指腸上緣4例。左肝管與右肝管低位匯合7例，右肝管后支低位匯合5例。9例伴有膽管狹窄：左右肝管開口狹窄4例，右肝膽管開口狹窄3例，左肝管開口狹窄2例。左右肝內(nèi)膽管結(jié)石7例，右肝內(nèi)
2、膽管結(jié)石3例，左肝內(nèi)膽管結(jié)石2例。膽囊管匯入右肝管5例，左肝管2例，肝總管5例。左、右肝管低位匯合7例行雙“T”管引流術(shù)；右肝管后支低位匯合5例行“T”管引流術(shù)。12例左、右(后支)肝管低位匯合病例術(shù)中右肝管后支不同程度損傷4例，右肝管損傷1例。結(jié)論左、右(后支)肝管低位匯合異常術(shù)前不易確診。術(shù)前MRCP或ERCP檢查，了解左、右管低位匯合及右肝管后支存在的可能，有利于指導(dǎo)手術(shù)，可避免發(fā)生膽道醫(yī)源性損傷?！娟P(guān)鍵詞】肝管，總；膽囊切除術(shù)；肝管低位匯合；膽管損傷Abnormallowconfluenceofthehepaticductsincasesofcholedocholith
3、iasisuZh@ang．RenPeitu．DepartmentofHepatobiliarySurgery，ShaoxingPeoplesHospital，Shaoxing312000，ChinaCorrespondingauthor：RenPeitu，E—mail：sxrenpeitu@163．corn【Abstract】0bjectiveTostudythediagnosisandtreatmentofcholedocholithiasisinpatientswithlowleftandrightposteriorhepaticductconfluence．Methods
4、Clinicaldataof12patientssufferingfromcholelithiasiswithalowconfluenceoftheleftandrightposteriorhepaticductsadmittedbetweenJanuary2000toJune2013wereretrospectivelyanMyzed．ResultsOfthe12cases．theleftandrightposteriorhepaticductsjoinedbetween2cmbelowhilushepatisaridthesuperiorborderoftheduodenu
5、min8cases，belowthesuperiorborderoftheduodenumin4cases．Sevencaseshadalowconfluenceoftherightandlefthepaticducts，and5caseshadrightposteriorductlowconfluence．Asforbileductstricture：theopeningstrictureattheiunctionoftherightandlefthepaticductswerefoundin4cases，theopeningstrictureintherighthepati
6、cductswerefoundin3cases．theopeningstrictureofthelefthepaticductwerefoundin2cases．Therewereleftandrightbileductstonesin7cases．rightintrahepaticbileductstonesin3cases，leftintrahepaticbileductstonesin2cases．Cysticductioinedtherighthepaticductin5cases，lefthepaticductin2cases．Sevencaseswithalowco
7、nfluenceoftherightandlefthepaticductswerewithdouble“T”tubedrainage；fiveoflowrighthepaticductconfluenceweretreatedby“T”tubedrainage．Thefightposteriorbranchofhepaticductswereinjuredinfourcasesandrighthepaticductwasinjuredinone．ConclusionsLowconfluenc
