肝叶切除治疗肝内胆管结石37例体会

Hepatic lobectomy and segmental resection for intrahepatic bile duct stone

目的总结肝叶切除治疗肝内胆管结石的经验。方法回顾性分析2006年1月～2010年10月黄山首康医院肝叶切除治疗37例肝内胆管结石患者的手术治疗方法及疗效。结果 37例患者中左半肝切除17例,右肝部分切除2例,左半肝切除+右肝后叶下段切除的3例,左外叶切除的14例,左半肝联合尾状叶切除的1例,术中均同时行胆总管切开取石,同时行胆肠吻合的7例,T管引流的30例。术后发生并发症8例,包括切口感染3例,创缘液化坏死3例,胆漏1例,胆道出血1例。术后残石1例,随访6月～4年,结石复发2例。结论肝叶切除是治疗肝内胆管结石安全、有效的方法。

Objective To summarize the therapeutic experience of hepatectomy for patients with hepatolithiasis.Methods From Jan 2006 to Oct 2010,37 patients were diagnosed as hepatolithiasis and were treated by hepatectomy in Huangshan Shoukang Hospital.Retrospective analysis was performed to analyze the treatment methods and curative effects on all of 37 cases.Results During the treatment of 37 cases,17 cases using left lobe hepatectomy,2 cases using right lobe hepatectomy,3 cases using left lobe and right posterior inferior segment hepatectomy,14 cases using left external lobe hepatectomy,the last one using left and caudate lobe hepatectomy.All of cases were performed choledochotomy.Meanwhile 7 cases had hepaticojejunostomy,30 cases T-tube drainage.Eight post-operative complications occurred,including surgical-wound infection（3 cases）,liquefactive necrosis（3 cases）,bile fistula（1 case）,hemobilia（1 case）.After surgery,there were residual gallstone（1 case）,gallstone recurrence（2 cases after 6-month to 4-year follow-up）.Conclusion Hepatectomy is a considerably safe and effective method in treating hepatolithiasis.