选择性肝血流控制下的解剖性肝叶切除在肝内胆管结石治疗中的应用

Application of the anatomical hepatectomy under the selective hepatic vascular control in the treatment of intrahepatic bile duct stones

目的:研究分析在肝内胆管结石治疗中采用选择性肝血流控制下的解剖性肝叶切除方案的效果,为临床研究提供有效的理论依据。方法:2008年1月-2013年12月收治单侧肝胆管结石患者166例,其中左肝结石84例,右肝结石36例,全肝结石46例,合并胆总管结石患者56例,合并胆管狭窄30例,合并左肝内胆管癌4例。针对患者的不同症状情况采用针对性治疗。结果:术后发生并发症症状20例(12%),死亡2例(1.2%)。142例治疗后无残留结石,10例有残留结石,10例中途放弃治疗并失去随访,4例经1年后再次治疗获得成功治愈。随访中,除放弃治疗患者外,未见任何复发病例。结论:将选择性肝血流控制下的解剖性肝叶切除手术应用于单侧肝内胆管结石的治疗中可有效减少患者手术治疗过程中的出血量和术后并发症情况,值得临床重视和推广。

Objective:To research and analyze the effect of the anatomical hepatectomy under the selective hepatic vascular control in the treatment of intrahepatic bile duct stones,to provide an effective theoretical basis for clinical studies.Methods:166patients with unilateral bile duct stones were selected from January 2008 to December 2013.84 cases were left liver stones;36cases were right liver stones;46 cases were whole liver stones;56 cases were biliary calculi;30 cases were merge bile duct stricture;4 cases were merge left intrahepatic cholangiocarcinoma.According to the different symptoms in patients with the use of targeted therapy.Results:After surgery,20 cases(12%)with symptoms of complications;2 cases(1.2%)died.After treatment,142 cases had no residual stones;10 cases had residual stones;10 cases dropped out treatment and lost follow-up;4 cases by 1 year had a successful cure after treatment again.During follow-up,in addition to abandon the treatment of patients,it did not show any recurrence.Conclusion:The anatomical hepatectomy under the selective hepatic vascular control in the treatment of intrahepatic bile duct stones can effectively reduce the amount of bleeding during surgery treatment and postoperative complications.It is worth to attention and promotion.