沿肝中静脉解剖性半肝切除治疗肝胆管结石病

Anatomical hemihepatectomy guided by middle hepatic vein in the treatment of hepatolithiasis： a report of 33 cases

目的总结沿肝中静脉解剖性半肝切除术治疗肝胆管结石病的经验以及评价其疗效。方法回顾性分析南京鼓楼医院肝胆外科2009年3月至2013年8月因肝胆管结石病行沿肝中静脉解剖性半肝切除的病例资料，统计临床表现、手术资料、术后并发症及治疗效果。结果纳入研究者33例，其中男性13例，女性20例，平均年龄50．6岁。左半肝切除22例（66．7%），右半肝切除11例（33．3％）；术中平均出血量为360ml，术中输血3例（9．1％）。术后发生并发症8例（24．2％o），其中腹腔感染2例（6．1％），胆漏1例（3％），另轻微并发症5例（15．1％）。围手术期无死亡及再手术病例。平均随访34个月，术后结石复发4例（12．1％），其中再次手术1例（3％）。结论在重视个体化评估、围手术期处理和创新手术技术的前提下，沿肝中静脉解剖性半肝切除术能使肝胆管结石病的手术治疗保持低并发症发生率和低结石复发率。

Objective To summarize our experiences and evaluate the therapeutic efficacies of anatomical hemihepatectomy guided by middle hepatic vein in the treatment of hepatolithiasis. Methods The clinical data of hepatolithiasis patients undergoing anatomical hemihepatectomy from March 2009 to August 2013 were retrospectively analyzed. The clinical manifestation, operative data, postoperative complications and therapeutic efficacies were evaluated. Results There were 13 males and 20 females with an average age of 50.6 years. Left hemihepatectomy （n = 22, 66. 7%） and right hemi- hepatectomy （n = 11,33.3 %） were performed. The average intraoperative blood loss was 360 ml and 3 cases （9. 1%） required intraoperative blood transfusion. Postoperative complications occurred in 8 （24. 2 %） cases, including abdominal infection （n = 2）, biliary leakage （n = 1） and minor complications （n = 5）, No perioperative mortality was reported. The average follow-up period was 34 months. 4 cases had recurrent hepatolithiasis and 1 underwent reoperation. Conclusions For individual assessment, perioperative management and technologieal innovation, anatomical hemihepatectomy guided by middle hepatic vein is an effective treatment for hepatolithiasis.