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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。
Objective: To investigate the prevention, diagnosis and treatment of liver failure after multiple extrahepatic bile duct stones. Methods: From January 2011 to December 2013, 126 patients underwent surgical treatment of multiple extrahepatic bile duct stones and 6 patients with postoperative liver failure. All patients underwent combined hepatectomy. Timely and accurate diagnosis of liver failure after anti-inflammatory, liver protection, hemostasis, blood transfusion, glucocorticoid, acid suppression, human serum albumin, diuretic, blood ammonia lowering, plasma exchange and symptomatic treatment and other treatment. Results: Before discharge from the hospital, 6 patients had 28.3-58.7 mmol / L of total bilirubin, 16-62 U / L of alanine aminotransferase, 12-85 U / L of aspartate aminotransferase, 32.1-37.8 g / L of plasma albumin, Basically normal, ascites disappeared, normal blood ammonia, upper gastrointestinal bleeding stopped. After discharge from 12 to 35 days, an average of 18 days. Six patients were followed up for a long time and all survived. Conclusion: Liver failure is one of the most serious complication after liver and biliary tract surgery. Adequate preoperative preparation and assessment, timely diagnosis and treatment after operation can significantly reduce the mortality rate.