解剖式肝段切除治疗左肝胆管结石——保肝手术的探讨

Anatomical segmental hepatectomy procedure for left intrahepatolithiasis

目的:总结解剖式肝段切除治疗左肝胆管结石的效果。方法:采用解剖式肝段切除治疗左肝胆管结石38例。其中左肝内外叶胆管均有结石12例,单纯左肝外叶胆管结石26例,合并胆囊结石19例,胆总管结石30例。同时伴有左肝管口狭窄10例;伴肝门部胆管狭窄3例。结果:S2切除26例,S3切除12例,另附加S4a切除5例,S4a+b切除3例。合并行带蒂自体组织瓣肝门部胆管及左肝管狭窄部成形13例;加行胆总管空肠Roux-en-Y吻合术2例;术中使用纤维胆道镜探查取石者29例,术中经纤维胆道镜通路高能震波碎石者16例。术后并发症发生率为13.1%;无手术死亡。疗效总优良率97.36%。结论:解剖式肝段切除术能够有效清除结石,并发症少,可防止术后胆石复发及肝脏旋转变形。

[ABSTRACT] Objective： To investigate the therapeutic effects of anatomical segmental hepatectomy for patients with hepatolithiasis. Methods： From January 2005 to June 2008,anatomical liver resection procedure were completed in 38 patients with left intrahepatolithiasis and the therapeutic efficacy were evaluated. Results： Thirt-eight patients with left intrahepatolithiasis were included in this study, 12（31.5%） with left lateral intrahepatotithiasis, 26（68.4%） with left intrahepatolithiasis, 19（50%）with cholecystolithiasis, 30（78.4%） with common duct stones, 10 with hepatobiliary stricture,3 with hitar stricture. Of 38 patients,26 received Ⅱ segmentectomy , 12 received Ⅲ segmentectomy ,5 received additional Ⅳa segmentectomy, 3 received additional Ⅳa＋b segmentectomy.13 patients received recondition of hepatobitiary stricture by self tissue piece with blood supply. All operations included segmentectomy associated with hepaticojejunostomy in 2 cases. The postoperatice complications were found in 5 cases （13.1%）and no patients died post operation. 21cases had been followed up for 3 months to 7 years,and the effect of 20 cases （97.3%）was excellent or good. Conelusion： Anatomic liver resection is safe and effective for left intrahepatotithiasis, and it could decrease the incidence rate of the liver proliferation and rotation.