一种新的基于胆道解剖及病理的肝胆管结石临床分型

A new clinical classification of hepatolithiasis based on biliary anatomy and pathology

目的探讨一种基于胆道解剖及病理的肝胆管结石新临床分型,以期指导临床决策。方法将我院2015年3月至2018年8月收治的肝胆管结石病例按照胆道解剖、结石部位及范围、肝脏病理变化、Oddi括约肌功能归为六型和一个附加型;并基于此分型进行个体化精准解剖性联合肝段或分肝段切除手术治疗。结果214例肝胆管结石病例中Ⅰ型5例(2.3%);Ⅱ型41例(19.2%);Ⅲ型76例(35.5%);Ⅳ型17例(7.9%);Ⅴ型29例(13.5%);Ⅵ型46例(21.5%)。最常见并发症为切口感染28例(13.1%)。肝衰竭0例,围手术期死亡0例。随访3个月至3年,14例结石复发,复发率7.6%。结论基于此新分型的“个体化精准解剖性联合肝段或分肝段切除”治疗肝胆管结石的手术方式,安全有效。

Objective To investigate a new clinical classification of hepatolithiasis based on biliary anatomy and pathology in order to guide clinical decision-making. Methods The cases of hepatolithiasis admitted to our hospital from Mar 2015 to Aug 2018 were classified into six types and an additional type according to biliary anatomy, stone site and extent, liver pathological changes, and Oddi sphincter function. Results Of the 214 cases of hepatolithiasis, 5 cases (2. 3%) were type Ⅰ;41 cases ( 19. 2%) were type Ⅱ;76 cases (35. 5%) were type Ⅲ;17 cases (7. 9%) were type Ⅳ;29 cases (13. 5%) were type Ⅴ;46 cases (21. 5%) of type Ⅵ. The most common complication was incision infection ( 28 cases, 13. 1 %), liver failure 0, and perioperative death 0. During the follow-up from 3 months to 3 years, there were 14 cases of stone recurrence, the recurrence rate was 7. 6%. Conclusion This classification scheme and the w individualized precise anatomical combined hepatectomy or segmental hepatectomyn based on this classification is safe and effective while enhancing the cure rate.