解剖性肝切除治疗复发性肝胆管结石病

Effectiveness and experience of anatomic hepatectomy for recurrent hepatolithiasis

目的 探讨解剖性肝切除治疗复发性肝胆管结石的疗效及手术操作体会.方法 回顾性分析2010年1月至2015年3月采用解剖性肝切除技术治疗复发性肝胆管结石35例的病例资料.结果 本组病例全部顺利完成手术,结石分布区域及肝叶定位通过术中B超和胆道镜准确定位,全部未行肝脏血流阻断,手术时间为（228.1±66.8）min,断肝时间为（126.2±53.8） min,术中出血量为（402.9±329.1）ml,断肝出血量为（158.2±87.9） ml,术中B超探查无结石残留,术中无管道系统损伤,术后住院时间为（7.6±3.5）d,术后出现手术相关并发症（胆漏、腹腔出血和腹腔感染）2例（5.71％）,均经过保守治疗治愈,术后无肝衰竭病例,32例获得随访,2例胆总管结石复发内镜治愈.结论 解剖性肝切除治疗复发性肝胆管结石能够彻底去除结石和病灶,降低复发率,减少并发症,是唯一可能治愈肝胆管结石的方法,术中胆道镜联合术中B超是解剖性肝切除的基础.

Objective To investigate the effectiveness and experience of anatomical hepatectomy for recurrent hepatolithiasis. Methods The data of 35 cases of recurrent hepatolithiasis undergoing anatomical hepatectomy in our center from Jan. 2010 to Mar. 2015 were analyzed retrospectively. Results The location of stones and the range of resected liver tissue were determined by intraoperative B-ultrasound and choledochoscopy, and the hepatic blood flow was not occluded. The operative time was （228. 1 ±66. 8） min, and the time of resected liver was （126. 2 ±53. 8） min. The volume of intraoperative blood loss was （402. 9 ±329. l） mL [The volume of blood loss during resecting liver was （158. 2 ±87. 9） mL]. No stones were remained through the checking of intraoperative B-ultrasound. No bile duct and artery were injuried. The postoperative hospital stay was （7. 6 ±3. 5） days. The rate of post- operative complications （bile leakage, abdominal bleeding and abdominal infection） was 5.71 % and the complications were cured by conservative treatment. No liver failure occurred. Thirty-two cases were followed up. Two cases of recurrent choledocholithiasis were cured by ERCP. Conclusions Anatomical hepatectomy for recurrent hepatolithiasis could completely remove stones and lesions, and reduce the rate of stone recurrence and complications. The intraoperative choledochoscopy in combinatio with B- ultrasound was the foundation.