肝圆韧带径路手术治疗左肝内胆管结石

Operative method by round ligament approach for left localized hepatolithiasis

目的探讨肝圆韧带径路手术治疗左肝内胆管结石的方法及临床疗效。方法回顾分析1999年8月-2007年12月采用肝圆韧带径路手术治疗左肝内胆管结石26例,术后观察患者的疗效与预后。结果26例患者根据结石部位及胆管狭窄情况的不同,采用了不同的肝段切除或联合肝胆管盆式内引流术式。本组患者死亡率为0,术后发生并发症4例,发生率为15.38%,包括胆瘘1例（3.85%）,膈下脓肿1例（3.85%）,切口感染2例（7.69%）。术后残余结石1例,残石率为3.85%。术后随访超过2年19例,结石复发2例,复发率为10.53%。结论肝圆韧带径路手术治疗左肝内胆管结石,简便、易行,术后残石率及结石复发率低,且并发症少,是治疗左肝内胆管结石的安全、有效方法。

Objective ： To explore the operative method by round ligament approach and curative effect of surgical treatment for left localized hepatolithiasis. Methods ： Twenty - six cases of left localized hepatolithiasis from August 1999 to December 2007 were analyzed retrospectively. Results ： According to position of stones and intrahepatic bile duct stricture, 26 cases were treated by hepatectomy or combined hepatobiliary - basin drainage. The operation mortality was 0%. Postoperative complications occurred in 4 （ 15.38% ）, bile leas in 1 （3.85%）, subphrenic abscess in 1 （3.85%）, incision infection in 2 （7.69%）. Postoperative residual stones occurred in 1 （3.85%）. Ninteen cases were followed up over two years, and recurrent stones occurred in 2（ 10.53% ）. Conclusion： The operative method by round ligament approach is an effective and safe surgical method for left localized hepatolithiasis, with low remaining rate and recurring rate after operation and few postoperative complications.