以病变胆管为导向的规则性肝切除治疗区域型肝胆管结石

Experience of regular hepatectomy oriented by pathological bile duct for the treatment of regional hepatolithiasis

目的探讨以病变胆管为导向的规则性肝切除治疗区域型肝胆管结石的可行性和手术体会。方法回顾性分析我院2016年6月~2019年12月采用以病变胆管为导向的规则性肝切除方法治疗区域型肝胆管结石的25例病例资料。结果通过术中胆道镜确定狭窄胆管的具体属支,结合术中B超明确所要切除的肝脏区段,本组资料中有5例重新评估了结石所在的区域,并改变肝切除范围,纠错率为20%,3例由肝脏左外叶切除改成左半肝切除,2例由右半肝切除缩小为右肝后叶切除,25例中左半肝切除8例,左肝外叶切除5例,右半肝切除2例,右肝后叶切除7例,右肝前叶切除3例,其中解剖性切除18例,非解剖性切除7例,平均手术时间为186.5±81.6min,断肝时间为84.9±36.5min,术中出血量为462.8±213.6ml(断肝出血量为167.5±65.2ml),术后住院时间为6.5±2.8d,结石取尽率为100%,术后出现胆漏3例,腹腔感染1例,均经过保守治疗治愈,无死亡病例,25例均获得随访,未见复发。结论以病变胆管为导向的规则性肝切除更为准确地切除病变胆管和保留更多的肝组织,有利于预防复发和减少创伤,是治愈肝胆管结石病的良好方案。

Objective To investigate the feasibility and experience of regular hepatectomy oriented by pathological bile duct for the treatment of regional hepatolithiasis.Methods The data of 25 cases of hepatolithiasis underwent regular hepatectomy oriented by pathological bile duct in our center from Jun 2016 to Dec 2019 were analyzed retrospectively.Results All of the patients were determined the location of stones and the range of resected liver tissue by intraoperative B-ultrasound and choledochoscopy,and Five cases were detected the difference from preoperative judge.Three cases were magnified from left lateral lobe of liver to left liver,and two cases were minifed from right liver to right lobe.18 cases were operated by anatomical hepatectomy,The operative time was 186.5±81.6min,but the time of resected liver was 84.9±36.5min,The volume of intraoperative blood loss was 462.8±213.6ml(The volume of blood loss during resecting liver was 167.5±65.2ml ml),No stones were remained through the checking of intraoperative Bultrasound,No bile duct and artery were injuried,The postoperative stay of hospital was 6.5±2.8d,The rate of postoperative compli-cations(3 patients of bile leakage and one of abdominal infection)was 16% and been cured by conservative treatment,No patients accured liver failure,25 cases were followed up and no case recurred.Conclusions Regular hepatectomy oriented by pathological bile duct could more accurately remove the pathological bile duct and remain more hepatie tssues,prevent the recurrence of stone and reduce the trauma,It is an ffctive therapeutic method of hepatolithiasis.