肝部分切除治疗肝内胆管结石50例体会

HEPATECTOMY FOR THE TREATMENT OF HEPATOLITHIASIS IN 50 CASES.

目的探讨肝部分切除术治疗肝内胆管结石的疗效。方法回顾分析1997年1月至2004年6月50例肝内胆管结石采用肝切除治疗的术式和治疗效果。结果围手术期死亡2例,1例术中出血,1例术后中毒性休克继发肝、肾功能衰竭,手术病死率4.0%。术后残余结石7例,经术后胆道镜治疗,均取净结石。33例获随访1月至7年,2例症状复发,仅于发作时在当地抗炎治疗。1例肝胆管癌者术后4月死于全身衰竭。结论肝切除是治疗肝内胆管结石的有效手段,对于多数病人来说,附加引流术是必要的,规则的右肝切除需有丰富的经验和娴熟的技巧,应尽可能避免行急诊肝切除手术,术中、术后胆道镜是提高疗效的重要措施。

Objective To investigate the efficiency of hepatectomy for hepatolithiasis. Methods The efficiency and patterns of operation were retrospectively analysed on 50 eases of hepatolithiasis from January, 1997 to June, 2004. Result 2 cases were died in perioprative period, 1 hemorrhage during the operation, 1 toxic shock with with liver and kidney failure. The operative mortality occurred in 4.0% patients,7 patients had residual stones,which were extracted attributed to the therapy of eholedoehoscopy postoperation. 33 cases were followed up from 1 month to 7 years, 2 cases recurrence, 1 case with eholangioeareinoma died of cachexia. Conclusion Hepatectomy is the effective treatment. For the most of the patients, additional hiliary drainage procedure is neceerssary. Anatomic hepatic resection required more surgical technology,emergency hepatectomy should be avoided, Intraoperative and postoperative choledochoscopy can be accept as the efficient method.