肝切除治疗肝内胆管结石

目 的探讨肝切除在肝内胆管结石治疗中的应用及其相关临床问题。方法 参照肝内胆管结石分型方法，回顾性分析35例肝内胆管结石临床资料。结果 35例病人的分型分别为：Ⅰ型2例，Ⅱ型17例，Ⅲa型9例，Ⅲb型5例，Ⅲc型2例。共行肝段或肝叶切除24例次，胆道成形13例次，胆肠吻合18例次，单纯取石3例次。肝切除主要用于Ⅱ型、Ⅲa型和Ⅲb型病人。肝切除范围包括左外叶6例、左半肝12例、右半肝3例，右后叶3例，右前叶1例。结论 肝切除是肝内胆管结石外科治疗的重要手段，技术上有其特点，准确全面影像指导下的个体化治疗是保证肝内胆管结石疗效的基本策略。

THE APPLICATION OF HEPATECTOMY IN THE TREATMENT OF INTRAHEPATIC STONE

Objective To explore the roles of hepatectomy in the treatment of intrahepatic stone, and to analyze the related clinical problems. Methods the clinical data from 35 cases of intrahepatic stone were retrospectively analyzed. Result 35 cases （ 13 males and 22 females） of clinically diagnosed intrahepatic stone were divided into three types： 2 cases Ⅰ type, 17 cases Ⅱ type, 16 cases Ⅲ type. The Ⅲ type was further divided into three subtype： 9 cases Ⅲa,5 cases Ⅲb and 2 cases Ⅲc. Among the 35 cases, 24 cases received hepatectomy, 13 cases received reconstruction of hilar bile duct, and 18 cases received cholangioenteric anastomosis. Almost all cases receiving hepatectomy belonged to the type Ⅱ or Ⅲ. Conclusion Hepatectomy has important roles in the treatment of intrahepatic stone, based on the location of the stone and the degree of hepatic parenchyma atrophy. The comprehensive radiological investigation of bile duct system is very important for the treatment of this disease.