肝切除术治疗肝内胆管结石20年的演变

Liver resection in hepatolithiasis： 20-year＇s evolution

目的分析肝内胆管结石肝切除术的治疗效果及相关因素。方法回顾性分析解放军总医院1986至2005年245例连续性肝内胆管结石肝切除术病例的临床资料。结果20年间肝内胆管结石肝切除术病例数占同期所有肝切除术治疗良性肝胆疾病病例数的29．6％（245／827），其中男性88例，女性157例，平均年龄（46．9±11．3）岁。肝切除术的范围，与1963至1985年相比，涉及右肝切除和肝段切除者明显增多。术中输血者占45．3％，术后并发症发生率16．3％，其中感染性并发症3．3％，胆漏2．4％，术后平均住院时间（15．7±9．2）d，围手术期病死率0．4％（1／245）。结论个体化的肝切除术是肝内胆管结石外科治疗上的重要手段。在重视优化围手术期处理和创新手术技术的前提下，能够使肝内胆管结石肝切除术保持低并发症发生率和低病死率。

Objective To analyze operative and perioperative factors associated with hepatectomy in hepatolithiasis. Methods 245 consecutive hepatolithiasis patients undergoing bepatectomy from January 1986 to December 2005 at Chinese People＇s Liberation Army General Hospital were investigated retrospectively according to medical documentation. Results Hepatolithiasis accounted for 29. 6% （245/ 827） in all benign liver diseases treated with hepatectomy during this time period. There were 88 cases in male and 157 cases in female,the average age was （46. 9 ± 11.3 ）years. Cases of right liver resection and hepatic segments resection were much more than that in 1963-1985. Blood transfusion during operation was given in 45.3% of cases. Complication incidence was 16. 5%, with infection 3.3% and bile leakage 2. 4%. Length of stay after operation was （ 15.7 ± 9. 2 ） days. Perioperative mortality rate was 0.4% （ 1/245 ）. Conclusions Individualized hepatectomy is the important surgical treatment of hepatolithiasis. Hepatectomy ean be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.