左肝外叶切除术治疗肝内胆管结石效果的评价

The evaluation of therapeutic effects of left external lobectomy of liver on hepatolithiasis

目的比较左肝外叶切除术和仅行胆总管切开取石术两种方法治疗肝内胆管结石的效果。方法对中山大学第三医院2000年1月至2004年12月收治的85例肝内胆管结石病人同期分别采用两种手术方法治疗。第1组44例,采用胆总管切开取石、左肝外叶切除和T管引流术的方法,第2组41例病人采用胆总管切开取石、T管引流术的方法。对两组的疗效进行分析总结。结果第1组术后近期效果优良率为90.9%,而第2组为80.5%。第2组在手术时间、术中出血量和输血量方面较第1组有明显的优势。第1组病人在术后残石率、胆道感染率和再手术率方面明显低于第2组。结论左肝外叶切除术治疗肝内胆管结石能取得比较好的临床效果,远期疗效明显好于仅行胆总管切开取石术。对肝内胆管结石较多、病灶较复杂、肝内胆管病变严重的病例,胆总管切开取石、T管流术不是一种“根治性”手术。

Objective To compare the therapeutic efficacy of left lateral lobeetomy of liver with the section of common bile duct and calculus remove only on hepatolithiasis. Methods Forty-four patients with hepatolithiasis were performed by the section of common bile duct and calculus remove,left lateral lobectomy of liver and drainage with T-tube （ the first group）. Meanwhile, the procedure was performed for another 41 cases of hepatolithiasis with the section of common bile duet,calculus remove and drainage with T-tube （ the second group ）. The therapeutic efficacy of these two groups were summarized and analyzed. Results In the first group, the rate of fine postoperative result in short-term was 90. 9%, but the second group was 80. 5%. The second group was significantly fewer than the first group in the operative time,volume of surgical bleeding and blood transfusion. The first group was significantly better than the second group in the rate of residual calculus, cholangitis, and second-operation. Conclusion The left lateral lobectomy of liver is effective in the treatment of hepatolithiasis, and its long-term efficacy is significantly better than the procedure of section of common bile duet and calculus remove only. Section of common bile duct, calculus remove and drainage with T-tube is not a radical procedure for cases with more serious and complicated calculus and abnormality of intrabepatie duct.