精准肝叶切除在肝内外胆管结石患者中的应用

目的:探讨精准的解剖性肝叶切除和局限性肝叶切除术对肝内外胆管结石患者的疗效。方法:回顾性分析我院2008年5月至2013年5月肝叶切除治疗肝内外胆管结石患者共182例,其中101例行局限性肝叶切除术,81例患者行精准肝叶切除术。分析患者肝功能恢复时间、残余结石、肝断面感染、胆瘘、复发结石、手术并发症发生率及死亡率。结果:两组间肝功能恢复时间无明显差别,精准性肝叶切除术后残余结石率较低,肝断面感染率较低,胆瘘较少,术后平均随访时间32.6月,精准肝叶切除术后结石复发率低。两组术后并发症发生率及死亡率差别无统计学意义。结论:精准的解剖性肝叶切除治疗肝内外胆管结石是一种有效的方法,术后并发症发生率低,结石复发率低。

Application of precise hepatolithiasis in choledochotomy patients

Objective：To explore the clinical effects of precise anatomical hepaolithiasis and restricted hepaolithiasis in choledoehoto my patients. Methods：Retrospectively analyze 182 choledochotomy patients who underwent hepatolithiasis from May 2008 to May 2012. 101 patients underwent restricted hepaolithiasis and 81 patients underwent precise anatomical hepaolithiasis. The recovery time of hepat- ic function, residual stones, infection of the liver remnant, bile leakage, recurrent stones, morbidity and mortality has been analyzed. Re- sults ： There is no difference in the recovery time of hepatic function between the two groups. There are less residual stones,less infection of the raw surface of liver remnant,less bile leakage and lower rate of recurrency of stones in precise hepaolithiasis group. The average time following-up activities is 32. 6 months. There is no statistical difference in morbidity and mortality between the two groups. Conclusion： Precise anatomical hepaolithiasis is an effective treatment for choledochotomy with a low rate of complications and recurrent stones.