肝段(叶)切除治疗肝内胆管结石疗效分析

目的探讨肝段(叶)切除治疗肝内胆管结石的临床价值。方法回顾性分析1997年1月～2004年1月采用肝段(叶)切除治疗肝内胆管结石的115例病例资料。结果肝段(叶)切除 胆管空肠Roux-en-Y吻合28例(24．3％)；肝段(叶)切除 胆道探查72例(62．6％)；肝段(叶)切除 胆肠吻合口切开探查10例(8．7％)；肝段(叶)切除 胆道探查 右肝表面切开取石术5例(4．3％)，术后胆道常规留置T管。其中肝段(叶)切除手术包括左外叶88例，左半肝12例，右前叶7例，右后叶1例。不规则左和(／或)右肝切除术7例。病人均治愈，无死亡。术后发生并发症10例(8．7％)，其中切口感染7例，切口裂开3例，均治愈。术后均经T管行胆道造影及胆道镜检，发现结石15例，残石率13．0％。结论肝段(叶)切除术治疗肝内胆管结石具有疗效较好。残石率较低，并发症较少的优势。

A Therapeutic Analysis of Hepatic Segmentectomy for Intrahepaticolithiasis

Objective To evaluate hepatic segmentectomy for intrahepaticolithiasis. Method 115 cases of intrahepatic lithiasis underwent hepatic segmentectomy from January 1997 to January 2004 were retrospectively reviewed. Result Operations included segmentectomy associated with hepaticojejunostomy in 28 cases, bile duct exploration in 72 cases, choledochojejunosotomosis excision and exploration in 10 cases, extraction of stones via right liver superficial incision in 5 cases. T-tube rountinly placed postoperatively. Hepatectomy included left lateral lobectomy in 88 cases, left hemilobectomy in 12 cases, right anterior lobectomy in 7 cases, right posterior lobectomy in 1 case, wedge left and/or right hepatic resection in 7 cases. All patients cured without death. Conclusion Hepatic segmentectomy for intrahepaticolithiasis demonstrates the advantages of good effect, low incidence of residual lithiasis and complication.