肝胆管结石的肝切除术治疗

Hepatectomy treatmentfor hepatolithiasis

摘要：目的分析应用肝段及半肝切除术治疗肝胆管结石的临床疗效。方法回顾性分析2004年8月～2010年10月经肝切除治疗的51例肝胆管结石患者的B超、CT诊断，手术方法，疗效。结果肝胆管结石位于左外叶21例（41．2％），左半肝15例（29．4％），右肝后叶3例（5．9％），左右肝12例（23．5％）；尾状叶2例（3．9％）。合并肝胆管狭窄41例（80．4％），合并胆总管结石40例（78．4％）、胆囊结石8例（15．7％）；合并胆管细胞癌2例。右肝残余结石11例（21．6％），胆总管结石复发1例，术后并发症发生率为31．4％（16／．51），无围手术期死亡病例。共随访43例，随访率84．3％（43／51），其中疗效优81．4％（35／43），疗效良16．3％（7／43），疗效差2．3％（1／43）。Ⅲ级以上右肝胆管的残留结石11例，随访疗效优良率90．9％。结论肝切除术治疗能清除结石，解决胆管狭窄，既可去除胆管病灶，还可消除胆管可能癌变的后患。对于肝叶萎缩，症状明显的病人，只要其整体情况可耐受手术及余肝之功能可代偿，积极给予肝切除手术治疗是明智的。对Ⅲ级以上右肝胆管的残留结石，先采取临床观察是适宜的。

[Objective ] To analyze theclinical efficacy of Hepatectomytreatment for hepatolithiasis. [Methods] From August 2004 to October 2010,51 cases of hepatolithiasis by hepatectomy in patients with B ultrasound, CT di- agnosis, surgical methods and effectswere retrospectively analyzed. [ Result ] Hepatolith located in the left exteral lo- bel of 21 cases（41.2%）, 15 cases of left liver（29.4%）, 3 cases of right posterior lobe（5.9%）, 12 cases of left and right liver （23.5%）, 2 cases of caudate lobe （3.9%）. 41 cases of hepatic duct stricture （80.4%）, 40 cases of common bile duct stone 78.4%）, 8 cases of cholecystolithiasis （15.7%）, 2 cases of cholangiocarcinoma. 11 cases of residual hepa- tolith of right liver （21.6%）. One case of choledocholith with recurrence, the percentage of treatment of complication was31.4%（16/51）, no death during the perioperative period. 43 cases of patients were followed-up after resection and the rate was 84.3%, 35 of cases had good efficacy（81.4%）, 7 of cases were good（16.3%）, one of case was bad （2.3%）. Right above the level III of intrahepatic duct residual stones in 11 cases. The followed-up patients had 90.9% good effect. [ Conclusions] Hepatectomy for hepatolithiasis treatment can eliminate the stones, solve intrahepatic duct stenosis and decrease the potential problem like intrahepatic duct cancer. Hepatectomy is the most effective method for those patients with serious liver atrophy. Clinical observations is appropriate for those patients with level III of intrahepatic duct residual stones.