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.