肝左右叶联合切除治疗复杂原发性肝胆管结石47例疗效分析

Treatment of complicated primary hepatic lithiasis by combined right and left lobectomy:an analysis of 47 cases

目的总结肝左右叶联合切除治疗复杂肝胆管结石的经验及其疗效。方法回顾性分析1991年8月至2007年8月第三军医大学西南医院肝左右叶联合切除治疗复杂的原发性肝胆管结石47例病人的临床资料,统计结石的分布、手术方式、术后并发症及治疗效果。结果47例病人中15例有胆道手术史。所有病例左右肝均有结石,其中7例合并尾叶结石,21例合并肝外胆管结石。术中发现合并肝内外胆管狭窄23例。所有病例均采用肝左右叶联合切除术,其中3例行右肝胆管树切除术,6例行右肝后叶胆管树切除术。附加手术:28例行胆道探查、T管引流术,19例附加胆管空肠Roux-en-Y吻合术,3例附加肝实质切开取石术。47例病人手术死亡2例。术后出现腹腔感染3例,右前叶结石残留1例,左内叶结石残留1例。随访16个月至17年,生活质量优良率为88.89%。结论肝左右叶联合切除治疗肝胆管结石并发症少、残留结石少、远期疗效好,是治疗复杂肝胆管结石的有效手段之一。

Objective To summarize the experience and evaluate the therapeutic effect of combined right and left lobectomy for complicated primary hepatic lithiasis. Methods To analyze retrospectively the clinical data of 47 patients suffering from complicated primary hepatic lithiasis underwent combined fight and left lobectomy from Aug.1991 to Aug. 2007. Stones distribution, operation style, postoperative complications and therapeutic effects were evaluated. Results 15 patients out of 47 patients had underwent operations on bile duct. All of the patients have stones in both right lobe and left lobe. Out of 47 patients, 7 patients have stones in caudate lobe, 21 patients have stones in extrahepatic bile duct. 23 cased of biliary stricture were found during operations. All of the patients underwent combined right and left lobectomy. Out of 47 patients, 3 patients underwent the resection of biliary tree of right lobe, 6 patients underwent the resection of biliary tree of right posterior lobe. Additional procedures include exploration of common bile duct in 28 patients, chole-enterostomy（Roux-en-Y） in 19 patients and intrahepatic lithotomy through hepatic parenchyma. Two patients died perioperatively. Three patients had intraperitoneal infection after operation. One patient had residual stone in right anterior lobe. One patient had residual stone in left interior lobe. The follow-up time is from 16 months to 17 years.88.89% of patients has excellent life quality. Conclusion Combined right and left lobectomy has less complications, less residual stones, excellent long-term results, thus is one of the effective procedures treating complicated primary hepatic lithiasis.