常温下半肝血流阻断在肝内胆管结石术中的应用分析

目的：探讨左肝内胆管结石的治疗方法，提高手术切除率，降低手术风险系数。方法：回顾性总结63例左肝内胆管结石患者在常温下阻断左半肝血流，行左肝叶切除、肝内含石胆管直视下切开取石和肝胆管Roux-en-Y胆肠吻合等手术后，患者术后并发症、肝内胆管结石的复发率、再手术率以及术后患者的肝功能恢复情况等。结果：本组无手术死亡，治愈率82.4%，好转率17.6%，残石率8.3%。并发症23例，胆漏2例，膈下感染4例，切口感染9例，术后转氨酶升高6例，消化道出血2例，全部并发症经非手术治疗全愈。经1～8年随访，复查B超、CT、肝功等检查，随访率87.7%；复发6例，复发率9.52%。结论：该方法可以控制肝切除术中的失血，保留了健侧肝脏的血运，术中及术后对肝功能损伤较轻。是一种比较简单、可行、合理的肝血流阻断方法。

Half-hepatic blood flow occlusion for hepatolithiasis at normal atmospheric temperature

Objective: To investigate an optimum method for left hepatolith to improve the operation response.Methods: Sixty-three cases of left hepatolith underwent operations of left-half hepatectomy,Roux-en-Y cholangio-jejunostomy and removal of stones by cholangiotomy under the condition of hemihepatic blood flow occlusion at normal atmospheric temperature.The postoperative complications,the index of liver function,the recurrent rate and the re-operation rate were evaluated.Results: No one died during the operations and the postoperative recovery rate,the improvement rate and the residual rate were 82.4%,17.6% and 8.3%,respectively.Complications were found in 23 cases,biliary fistula in 2 cases,subphrenic infection in 4,incisional wound infection in 9,transaminase lifting in 6 and digestive tract bleeding in 2,but they were all cured by non-operative treatment.During 1-8 years of follow-up,87.7% of the cases were rechecked by ultrasonic diagnosis B,CT and liver function test,and 6 of them had relapsed.Conclusion: The hemihepatic blood flow occlusion for hepatectomy is a feasible,reasonable and effective procedure due to good control of blood loss,retention of blood circulation in the healthy liver side,and lessening of intra-operation and post-operation liver dysfunction.