肝叶(段)切除在肝内胆管结石治疗中的应用

Application of hepatic lobectomy or segmentectomy in treatment of intrahepatic bile duct stone

目的探讨肝叶（段）切除在肝内胆管结石治疗中的应用价值。方法该院于2005年3月-2012年12月共收治肝内胆管结石患者138例。其中,肝叶（段）切除组67例,施行肝叶（段）切除的各种术式,同时行胆管空肠吻合26例,肝断面扩张胆管、肝门胆管与空肠双口吻合8例,T管引流术33例;非肝叶（段）切除组71例,其中胆总管切开取石＋T管引流术34例,胆总管切开取石＋胆肠吻合25例,肝胆管狭窄整形12例。结果随访6个月-6年,肝叶（段）切除组与非肝叶（段）切除组优良率分别为88.06%（59/67）,74.65%（53/71）,差异有显著性（P〈0.05）;两组的术后残石率分别为13.43%（9/67）和28.17%（20/71）,差异有显著性（P〈0.05）;肝叶（段）切除组与非肝叶（段）切除组的再手术率分别为1.49%和7.04%,并发症发生率分别为16.42%和14.08%,差异无显著性（P〉0.05）。结论肝叶（段）切除在肝内胆管结石治疗中有重要价值,能提高疗效,降低残石率。

[ Objective ] To investigate the clinical value of hepatic lobectomy or segmentectomy in the treat- ment of intrahepatic bile duct stone. [Methods] Of 138 patients with hepatolithiasis who were hospitalized in our hospital from March 2005 to December 2012, 67 were randomly assigned into hepatic lobectomy or segmentectomy group and 71 were assigned into no-hepatectomy group, respectively. 67 cases underwent operative styles of hepate- ctomy, simultaneously, 26 cases underwent cholangio-jejunostomy, 8 underwent double anastomosis between the dis- tended bile duct in the liver section and hepatic portal and jejunum, and 33 underwent T-tube drainage. Of 71 cas- es, 34 underwent choledochotomy and calculi removal plus T-tube drainage, 25 choledochotomy and calculi removal plus Roux-en-Y cholangiojejunostomy, and 12 stricture reshaping of intrahepatic bile duct. [Results] In the follow- up period of from 6 months to 6 years, there was statistical difference between hepatic lobectomy or segmentectomy and no-hepatectomy group in the superordinary rate （88.06% ,74.65% ） and postoperative retained calculi rate （13.43%, 28.17%）（P 〈0.05）. No statistical significance existed between hepatic lobectomy or segmentectomy group and no-hepatectomy group in the reoperation rate （1.49%,7.04%） and in complication incidence rate （16.42%, 14.08%）（P 〈0.05）. [ Conclusion ] Hepatic lobectomy and segmentectomy is valuable in the treatment of intrahepatic bile duct stone due to its increased curative effect and decreased retained calculi rate.