肝叶切除术治疗肝胆管结石780例临床分析

Clinical analysis of 780 hepatolithiasis cases underwent hepatectomy

目的探讨肝叶切除术治疗肝胆管结石的临床疗效及其影响因素。方法回顾性分析2007年1月~2012年12月在海南省人民医院接受肝叶切除术治疗的780例肝胆管结石患者的临床资料,包括病例的人口学特征、年龄、结石的分布、肝叶切除的分区、术后结石残留及随访情况等进行讨论分析。结果左肝外叶切除427例,占54.74%,左外叶上段切除286例,占36.67%,左外叶下段切除141例,占18.07%,左半肝切除96例,占12.31%,右前叶切除73例,占9.35%,右后叶切除105例,占13.46%,右半肝切除33例,占4.24%,双侧多区段切除46例,占5.90%。术后残石率10.38%,术后并发症发生率为14.36%;其中627例获得随访4个月-4年,优良率为94.26%,复发率为5.74%。结论肝叶切除术是治疗肝胆管结石行之有效的方法,复发率低,结石残留率低,治疗过程需要根据结石分布情况,同时进行附加手术,改善治愈率。

Objective To investigate the clinical effect of hepatectomy on hepatolithiasis cases and its influencingfactors. Methods The clinical data of 780 hepaolithiasis cases treated with liver lobe resection from Jan 2007 to Dec 2012were collected and their demographic characteristic, age, the distribution of the stone, the partition of hepatolithiasis,postoperative calculi residual and follow-up conditions were retrospectively analyzed. Results Four hundred and twenty-seven cases（54.74%）were treateded with left hepatic lobe resection, 286 cases（36.67%） with left lobe segments resection, 141cases（18.07%） with left lower lobe resection, 96 cases（12.31%） with left half liver resection, 73 cases（9.35%） with right anteriorlobe resection, 105 cases（13.46%） with right posterior lobe resection, 33 cases（4.24%） wiith right half liver resection, 46 cases（5.90%） with bilateral multiple segment resection. The postoperative residual stone rate was 10.38%, The incidence ofcomplications was 14.36%. In addition,627 cases were visited for four months to 4 years, good rate was 94.26% and therecurrent rate was 5.74%. Conclusions Hepatectomy is effective for treatment of hepatolithiasis cases with low recurrentrate and low calculi residual rate..