规则肝切除术治疗复杂肝内胆管结石的临床体会

Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy

目的探讨复杂肝内胆管结石行规则肝切除术的临床效果。方法回顾性分析石首市人民医院2013年1-12月98例复杂肝内胆管结石患者的临床资料,分析患者肝内胆管结石分布特点、临床表现、手术范围、手术时间、并发症及手术治疗效果。结果98例患者均完成规则肝切除术,37例行胆总管切开取石T管引流加肝段切除,6例行左肝外叶切除,1例行左半肝切除,7例行右半肝单独肝段及联合肝段切除,45例行左右半肝肝段联合切除,2例行肝门部胆管整形后胆肠盆式吻合。围手术期未出现患者死亡,手术时间(65.0±5.0)min;术中出血量(83.0±6.2)ml,术后无结石残留患者。5例(5.1%)患者出现并发症,其中3例患者并发胆漏,2例患者并发肝脏创面渗血。3例患者术后病理检查发现肝内胆管癌。随访5年,11例(11.2%)患者术后结石复发。结论规则肝切除术治疗复杂肝内胆管结石患者安全且疗效较好,并发症少,结石复发率低,值得临床推广应用。

Objective To investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December,2013. The distribution characteristics of intrahepatic bile duct stones,clinical manifestations,extent of operation,time of operation,complications,and surgical outcome were analyzed. Results All the 98 patients completed regular hepatectomy. Of all patients,37 underwent choledocholithotomy with T- tube drainage and segmental hepatectomy,6 underwent resection of the left lateral lobe of the liver,1 underwent left hemihepatectomy,7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy,45 underwent combined segmental hepatectomy of the left and right lobes of the liver,and 2 underwent biliary- enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65. 0 ± 5. 0 min,and the mean intraoperative blood loss was 83. 0 ± 6. 2 ml. No patients experienced residual stones after surgery. Of all patients,5（ 5. 1%） experienced complications,among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years,and 11（ 11. 2%） experienced recurrence of stones after surgery. Conclusion Regular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones,with few complications and a low recurrence rate of stones. Therefore,it holds promise for wide clinical application.