摘要
报告我科１９７５年～１９９４年９月１０００例肝胆管结石手术病例中采用肝叶、段切除４８２例的治疗经验与体会。该４８２例中６３％曾经历过１～５次手术，其中２１．６％为不同类型的胆肠吻合。肝切除术式；左外叶切除３２１例（６６．６％）；左半肝切除８０，例（１６．６％）；右半肝切除１９例（３．９％），左前或右后叶切除３９例（８．１％）；肝方叶切除作为附加手术２０例（４．１％）。手术并发症４９例（１０．２％），包括胆瘘、断面及膈下感染，胆道出血等。死亡９例（１．９％），４１０例（８５．１％）病例获平均１３．５年随访，优良率８８％。作者基于病因学及病理基础讨论了治疗要点，强调：①必须根据临床病理类型及病因学决定术式；②肝叶、段切除是治疗原则中的核心。
Four hundred and eighty two patients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection(from 1975 to 1994, 9)has reported. 63% of the patient in this group underwent 1-5 operations,including different types of binary-intestinal anastomosis(21. 6% ). 482 cases underwent different types of hepatectomy,Lncluding left lateral-lobectomy 321 cases (66. 6 % ),left hemihepatectomy 80 cases (16.6%),right hemihepatectomy 19 cases (3. 9 % ),and multiple segmental resections 39 cases(8. 1 %,including Ⅴ+Ⅶ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases(4. 1 % ). Postoperative complication rate was 10. 2%,including binary fistula. hemobilia and subdiaphragmatic and resectional surface infections, 85 % of the patients were fol lowed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy and segmental resection is the core of treatment and selection of opereative methods depends on clinical-patholigic types of the disease.
