肝叶段切除治疗肝内胆管结石237例

Report of lobectomy and segmentectomy for treatment of intrahepatic biliary cholelithaisis (237 cases)

目的探讨肝内胆管结石的术前诊断、肝叶段切除的部位和范围以及联合术式的应用与疗效。方法回顾性研究分析该院1995年1月～2006年12月237例肝内胆管结石肝叶段切除的病例,在237例中,根据肝内胆管结石的分布及胆管狭窄的部位,行左肝外叶切除+T管引流98例,左肝外叶切除+肝门胆管修复整形+T管引流19例,左肝外叶切除+肝门胆管整形+肝门胆管空肠Roux-en-y吻合术47例,左半肝切除+肝门胆管整形+肝门胆管空肠Roux-en-y吻合术14例,左肝外叶切除+左肝断面胆管空肠Longmire吻合3例,肝方叶切除+肝门胆管整形+肝门胆管空肠Roux-en-y吻合术17例,V、VI肝段切除+T管引流术11例,VI、VII肝段切除+T管引流术28例。结果术后随访时间8个月～11年(平均82个月),优良率达96.6%。1例于术后10d死于多器官功能衰竭,4例发生术后残石(1.7%),3例偶有胆管炎发作。结论重视术前诊断的准确性,根据肝内胆管结石的分布及胆管狭窄的部位,合理选择肝叶段切除的部位和范围及合理应用联合术式,可以获得良好的治疗效果。

[ Objective] To discuss the preoperative diagnosis, the location and scope of liver resection, the application and effect of joint operations in hepatolithiasis patients. [Methods] Retrospective analysis of 237 cases of the liver resections in hepatolithiasis patients from Jan. 1995 to Dec. 2006 12 in our hospital were made. In 237 cases, in accordance with intrahepatic bile duct stones and the distribution of the narrow site, 98 cases of hepatectomy for left lateral lobe ＋ T tube drainage, 19 cases of the hepatectomy for left lateral lobe ＋ portal bile duct repair drainage plastic ＋ T tube drainage, 47 cases of hepatectomy for left lateral lobe＋hepatic portal bile duct plastic ＋ Roux-en-y choledochojejunostomy, 14 cases of left hepatectomy in left half＋hepatic portal bile duct plastic ＋ Roux-en-y choledochojejunostomy, 3 cases of hepatectomy for left lateral lobe＋left hepatic duct Longmire choledochojejunostomy,17 cases of hepatectomy for quadratus lobe ＋ hepatic portal bile duct plastic ＋ Roux-en-y choledochojejunostomy, 11 cases of hepatectomy for V or VI segment ＋ T duct drainage, 28 cases of hepatectomy for VI or VII segment ＋ T duct drainage. [Results] The follow-up time between eight months and 11 years （average of 82 months）, excellent rate is 96.6%. One case was died of multiple organ failure after surgery, four cases were found with residual stone （1.7%）, three eases of occasional cholangitis attack. [Conclusion] Access to good treatment is attention to the accuracy of diagnosis, according to intrahepatie bile duct stones and the distribution of the narrow site, a reasonable choice hepateetomy of the location and scope, and reasonable application of joint operation.