肝部分切除术治疗肝胆管结石91例临床分析

目的：总结肝部分切除治疗肝胆管结石的临床经验。方法：回顾性分析91例肝胆管结石的定位诊断、手术方式、临床效果和手术并发症等情况。结果：术前行彩超检查91例（100％）、CT检查78例（85．7％）、MRI检查6例（5．5％）。术中发现合并胆管狭窄24例（26．4％），合并胆管癌2例（2．1％）。左外叶或左半肝切除71例（78．0％）、右叶各段切除18例（19．8％）、右半肝切除2例（2．2％）。术后并发症发生率19．8％，残石率18．7％。结论：彩超＋CT对肝胆管结石的术前定位诊断基本能满足术前对手术方式的制定；以肝段叶切除为主的综合治疗方案是治疗肝胆管结石的有效手段；术中、术后彩超、纤维胆道镜的运用及术后针对患者具体情况的对症治疗措施可提高临床效果，减少并发症。

Segmental Hepatectomy for Hepatolithiasis:Clinical Analysis of 91 Cases

Objective：To summarize the clinical experiences of the segmental hepatectomy for hepatolithiasis. Methods：The data of 91 cases included location,peration procedure,clinical effects and operation complications were retrospectively analized. Results .. Before operation, there were 91 patients （ 100 % ） examined by color Dopplor imaging, 78 （85. 7%）by CT and 6（5.5%） by MRI. In the course of operation,24 dases of these 91 patients had bile duct stricture and 2 had cholangiocarcinoma. The number of removal whole of or half of the left lateral lobe or the left hemi hepta was 71 （78.0%） ,one or more segments of the right liver 18 （19.8%） and the half of right liver 2 （2.2%） . After the opera- tion, 19.8 % of the 91 patients had complications and 18.7 % still had stones. Conclusion：Before the operation, the use of color Doppler imaging and CT were enough to locate the stones,which can generally determine the method of the operation. The comprehensive treatment plan which centers on the resection of hepatic segments is an effective way in the treatment for hepatolithiasis. In the pre-operation and during operation the application of color Doppler imaging and eholedochoscope could improve the clinical efficacy and decrease complications.