Surgical treatment of cavernous hemangioma of the liver

Cavernous hemangioma of the liver was surgically treated in six men and two women, mean age 58 (51-63) years during a 37-year period. The size of hemangioma averaged 10 (5-15) cm. It was single in all cases and situated in the right liver lobe in seven. The indications for operation were suspected abdominal tumor or hepatic metastases in five cases, enlargement of previously known hemangioma in two, and spontaneous rupture of cavernous hemangioma with massive intra-abdominal bleeding in one case (emergency laparotomy). The operations comprised two right lobectomies, one left lobectomy, three atypical resections of the right liver lobe and two sublobar resections. The course after the elective operations was uneventful, but the patient with ruptured hemangioma died intraoperatively due to myocardial fibrillation after performance of right lobectomy. Although elective surgical treatment of cavernous hemangioma of the liver is safe, the natural history in most cases probably is benign and indications for surgery should be restrictive.     

Caudate lobectomy: tumor location, topographic classification, and technique using right- and left-sided approaches to the liver

BACKGROUND: Resection of the caudate lobe (involving segments I [dorsal sector] and/or IX [right paracaval region]) often presents a technical challenge. It is difficult to perform because of its deep location and adjacency to the major hepatic vessels (ie, the left and middle hepatic veins). METHODS: A literature review was performed based on a Medline search to identify articles on caudate lobectomy published from 1990 to 2005. This article describes the right and left-sided approaches to the liver for caudate resection according to caudate lobe tumor location and topographic classification. RESULTS: The results of 377 lobectomies were analyzed in this review. The left-sided approach to the liver was used in 55 (14.58%), the right-sided approach in 24 (6.36%), and both approaches in 298 (79.04%) caudate lobectomies. Primary benign and malign liver tumors, as well as secondary liver tumors, were resected. CONCLUSIONS: Access to and resection of the caudate lobe should be determined on the basis of tumor location and hepatic function. The left or right approach to the caudate lobe can be recommended for local resection of tumor located at Spiegel's portion or process portion. Approaches to caudate lobectomy are therefore largely dependent on size and location of the lesion, type of associated resection, and presence of scarring from previous resection.     

Rupture of the hepatic artery after left hemihepatectomy for hilar bile duct carcinoma

Hilar bile duct carcinoma has a poor prognosis, but this has been improved in recent years by an aggressive surgical approach. We treated a 73-year-old woman who had obstructive jaundice due to bile duct carcinoma at the hepatic hilum. The jaundice decreased after percutaneous transhepatic biliary drainage. The tumor was resected with the left and caudate lobe of the liver and a part of portal vein. The right hepatic artery was located behind the common hepatic duct, and was suspected to be invaded by the tumor. We dissected the tumor from the arterial wall without carrying out combined resection of the hepatic artery. On the 6th postoperative day, the hepatic artery ruptured and the patient suffered hypovolemic shock. Resection of the hepatic artery and reconstruction were done, but the patient died 2 days later. Histological examination of the resected artery showed that the tumor had been curatively removed by dissection and that no tumor remained at the arterial wall. The rupture of the right hepatic artery was thought to have been caused by damage to the wall during the dissection procedure.     

包括腔静脉旁部的肝尾叶切除术

目的：探讨并总结包括腔静脉旁路肝尾叶切除的方法和经验。方法：分别采用右后途径和左侧途径行肝右尾叶和全尾叶切除;前者附加部分右后叶切除,后者可为单独全尾叶切除或附加左外叶或左半肝切除。结果：成功施行包括腔静脉旁部的肝尾叶切除13例,其中右尾叶切除7例,全尾叶切除6例;全组无手术死亡,术中,术后均无严重并发症发生;术中平均失血量为896.15ml,平均肝门阻断时间为25.4min,术后平均住院12d。结论：虽然肝门部解剖关系复杂,但手术切除包括腔静脉旁部的肝尾叶仍是安全可行的。     

腹腔镜规则性肝左外叶切除的临床应用暨文献复习

目的探讨腹腔镜规则性肝左外叶切除的安全性和有效性。方法腹腔镜下行规则性肝左外叶切除7例,其中肝左外叶巨大囊肿4例、肝左外叶巨大血管瘤1例、肝左外叶肝细胞癌1例、肝左外叶慢性化脓性炎1例。结果 7例患者均成功在腹腔镜下施行了规则性肝左外叶切除术,无中转开腹,手术时间(148.6±79.5)min,术中出血(280.0±218.4)ml,术后胃肠功能恢复(2.6±1.5)d,术后住院(9.1±4.7)d,均无胆漏、出血、腹水、感染、空气栓塞等并发症发生。结论在掌握手术适应证、精心的病例选择及具备丰富的腹腔镜操作经验的基础上,腹腔镜规则性肝左外叶切除是安全、有效的,可充分发挥腹腔镜技术的微创优势。     

肝左右叶联合切除治疗复杂原发性肝胆管结石47例疗效分析

目的 总结肝左右叶联合切除治疗复杂肝胆管结石的经验及其疗效。方法 回顾性分析1991年8月至2007年8月第三军医大学西南医院肝左右叶联合切除治疗复杂的原发性肝胆管结石47例病人的临床资料,统计结石的分布、手术方式、术后并发症及治疗效果。结果 47例病人中15例有胆道手术史。所有病例左右肝均有结石,其中7例合并尾叶结石,21例合并肝外胆管结石。术中发现合并肝内外胆管狭窄23例。所有病例均采用肝左右叶联合切除术,其中3例行右肝胆管树切除术,6例行右肝后叶胆管树切除术。附加手术：28例行胆道探查、T管引流术,19例附加胆管空肠Roux-en-Y吻合术,3例附加肝实质切开取石术。47例病人手术死亡2例。术后出现腹腔感染3例,右前叶结石残留1例,左内叶结石残留1例。随访16个月至17年,生活质量优良率为88.89%。结论 肝左右叶联合切除治疗肝胆管结石并发症少、残留结石少、远期疗效好,是治疗复杂肝胆管结石的有效手段之一。     

Hemoperitoneum from a Spontaneous Rupture of a Giant Hemangioma of the Liver: Report of a Case

Hemangioma is the most common benign tumor of the liver and it is often asymptomatic. Spontaneous or traumatic rupture, intratumoral bleeding, consumption coagulopathy, and rapid growth are mandatory surgical indications. We report a case of giant hemangioma of hepatic segments II and III, which presented as hemoperitoneum, and were treated successfully with preoperative transcatheter arterial embolization (TAE) and hepatic bisegmentectomy. A PubMed Medline search has identified up to now 32 cases of spontaneous rupture of hepatic hemangioma in adults (age >14 years) without a history of trauma, including the present case. Twenty-seven out of these were reviewed. Sixteen (84.2%) of 19 tumors of known size were giant hemangiomas (mean diameter 14.8 cm; range 6–25). Twenty-two (95.7%) patients underwent surgery. Thirteen patients (59.1%) had a resection, 5 (22.8%) were sutured, and 4 (18.1%) underwent tamponade. Three (23%) out of the 13 resected patients died. Four patients (30.8%) underwent TAE prior to elective hepatic resection without any operative mortality. Among the 5 sutured patients, 2 (40%) died as well as 3 (75%) out of 4 patients who underwent tamponade. The mortality rate of all surgery patients was 36.4% (8/22). Received: April 8, 2002 / Accepted: September 3, 2002 RID="*" ID="*" Reprint requests to: V. Ziparo     

肝切除术治疗肝血管瘤37例分析

目的 探讨肝血管瘤的诊断、手术指征及外科治疗效果.方法 回顾性分析2005年7月至2008年7月我院肝切除术治疗的37例肝血管瘤患者临床资料.所有病例均通过B超、增强CT和(或)MRI明确诊断.手术指征包括:(1)血管瘤直径>5 cm,位于左外叶或边沿部,伴有较明显临床症状;(2)血管瘤直径>10 cm或短期生长迅速.瘤体位于左叶10例,右叶17例,尾叶3例,肝中叶2例,左右叶多发5例.所有病例术前肝功能Child评级均为A级.结果 右半肝切除5例,左半肝切除2例,左外叶切除10例,尾叶切除3例,肝中央叶段切除5例,肝段切除8例,联合肝段切除4例,预防性胆总管切开、T管外引流2例.术中第一肝门阻断28例,阻断时间8～36 min,平均(22.2±14.3)min;全肝血流阻断7例,阻断时间10～40 rain,平均(21.6±12.1)min.术中输血4例,输血量平均为400 ml.所有手术病例过程顺利,切除标本直径5～20 cm,无手术死亡.术后并发症:胸腔积液4例,膈下积液2例.术后病理:37例均为肝海绵状血管瘤.所有病例随访6个月～4年,无复发.结论 在严格把握手术指征的前提下,应用肝切除术治疗肝血管瘤是安全有效的.

Abstract：

Objective To study the diagnosis,surgical indications, and results of surgical treatment for hepatic hemangioma. Methods The data of 37 patients with hepatic hemangioma treated by hepatectomy in our department from July 2005 to July 2008 were analyzed retrospectively. The diagnoses were made by ultrasound, enhanced CT and MRI. Surgical indications included: (1) diameter >5 cm, located at the left lateral section or the lower edge of the liver with symptoms. (2) diameter >10 cm or recent rapid growth. The hemangioma were located in the left liver in 10 patients, right liver in 17, caudate lobe in 3, middle hepatic lobe in 2, multiple tumors in left and right livers in 5.The preoperative liver function was grade A in all patients. Results Five patients underwent right hepatectomy, 2 underwent left hepatectomy, 10 underwent left lateral sectionectomy, 3 underwent caudate lobectomy, 5 underwent central hepatectomy, 8 underwent right anterior sectionectomy, 4 underwent combined hepatic resections and 2 underwent prophylactic exploration of the common bile duct. Pringle's maneuver was applied in 28 patients, and total hepatic vascular exclusion in 7. The occlusion time ranged from 8-36 and 10-40 minutes (average: 22.2±14.3 min and 21.6±12.1 min),respectively. 400 ml of intraoperative blood transfusion was given to 4 patients each. All operations were successfully carried out. The specimens measured 5-20 cm. There was no peri-operative death.The postoperative complications were: pleural effusion (n=4); subphrenic (n=2). Histologic diagnosis confirmed hepatic cavernous hemangioma in all patients. All patients were regularly followed-up (ranged 6 months-4 years), and no recurrence was detected. Conclusion In carefully selected patients, liver resection for hepatic hemangioma is safe and effective.     

Pathophysiology of major hepatic resection and benefits of preoperative portal embolization in preventing hepatic failure

The mechanism whereby hepatic failure after hepatectomy can be prevented by previous portal embolization (PE) was reviewed. To overcome the surgical stress of hepatectomy, adenosine triphosphate (ATP) energy-dependent protein synthesis of hepatic acute phase proteins and of intrahepatocytic protein is necessary for regeneration. To prevent hepatic failure after hepatectomy. ATP synthesis must exceed ATP consumption, a circumstance achieved by increasing the former or decreasing the latter. PE induces atrophy of the ipsilateral lobe and hypertrophy or hyperplasia of the contralateral lobe by hepatocyte regeneration. It also induces a partial shift of function, much as biliary excretion of indocyanine green (ICG) and bilirubin, from the ipsilateral to the contralateral lobe. The course and rate of the hypertrophy depend upon the patient's age, the extent of the area affected by the PE, the embolization material, and the degree of hepatic fibrosis of the contralateral lobe. In other words, PE may be regarded as atraumatic hepatectomy. Preliminary PE decreases the surgical stress of a hepatectomy by causing atrophy of the ipsilateral lobe and hepatocyte regeneration of the contralateral lobe in the interim, with a resulting decrease of ATP consumption during surgical hepatectomy. This two-stage procedure can prevent hepatic failure after hepatic resection and extends the range of indications for hepatectomy. Levels of the cytokines regulating hepatic regeneration after PE should be examined to determine whether hepatic regeneration is completed and hepatic resection can be performed without complication.     

Liver resection under total vascular isolation. Variations on a theme.

Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.     

腹腔镜肝左外叶切除术58例回顾性分析

目的回顾性分析58例腹腔镜肝左外叶切除术临床资料,并与开腹肝左外叶切除术对比,探讨腹腔镜肝左外叶切除术的可行性、优缺点和安全性。方法回顾性分析自贡市第四人民医院肝胆外科收治的行肝左外叶切除术患者166例,根据手术方式不同分为腹腔镜组(n=58)和开腹组(n=108)。对比观察两组一般情况、术中和术后相关指标、手术前后肝功能变化、术后并发症。结果两组手术均一次性成功,无术中死亡病例,均未出现术后再出血。腹腔镜组无中转开腹病例,切口长度、术后住院时间和胃肠道功能恢复时间短于开腹组,术中出血量少于开腹组,差异均有统计学意义(P0.05);两组手术时间比较差异无统计学意义(P0.05)。腹腔镜组ALT、AST水平低于开腹组,差异有统计学意义(F_(分组)=68.209、62.343,P0.05);两组ALT、AST水平表现出先升高后降低的趋势,术前、术后第1天和第3天比较差异有统计学意义(F_(时间)=228.300、179.556,P0.05);腹腔镜组ALT、AST升高幅度小于开腹组(F_(交互)=103.465、88.302,P0.05)。两组术后并发症发生率比较差异无统计学意义(χ~2=0.254,P0.05)。结论腹腔镜肝左外叶切除术是一种安全可行的手术方式,具有创伤小、术后恢复快等优势,建议有条件的医院推广使用。     

腹腔镜右肝后叶切除术治疗肝肿瘤临床价值分析(附76例报告)

目的探讨腹腔镜右肝后叶切除治疗肿瘤的安全性、有效性等临床价值。 方法收集2013年11月至2017年2月湖南省人民医院肝胆微创外科行腹腔镜右肝后叶切除术患者的临床资料,进行回顾总结,对腹腔镜右肝后叶切除治疗肿瘤的安全性及有效性进行分析。 结果本研究共纳入76例患者,其中70例患者在腹腔镜下完成右肝后叶切除术。行Pringle法阻断肝血流患者72.37%(55/76)。手术时间(266.04 ± 87.44)min;术中输血率10.53%(8/76);术中出血量(330.21 ± 163.51)ml;其中6例中转开腹手术,中转率7.89%(6/76),术后胆漏发生率2.63%(2/76);围手术期内无死亡病例及再手术病例,术后住院时间(7.14 ± 3.39)d。对所有的纳入患者随访6～36个月,出院后每3～6个月复查超声或CT。恶性肿瘤患者无瘤生存时间(18.38 ± 6.80)个月,随访期内无死亡病例。 结论在具有丰富腹腔镜肝切除经验的中心,严格其适应证、合理利用手术技艺和器械,完全腹腔镜右肝后叶切除术治疗肿瘤是安全、有效的,值得进一步推广。     

活体肝移植右半供肝切取的临床经验总结（附157例报告）

目的总结活体右半供肝切取的经验。方法对2002年1月至2009年8月在四川大学华西医院肝脏移植中心施行活体右半肝供体手术的157例患者的资料进行回顾性分析。全部供者均自愿无偿捐肝,其捐赠行为均经医院伦理学委员会批准。了解术前计算机体层摄影术（CT）评估供肝体积的效果：术前应用CT测定供体的全肝体积、右半肝体积（不含肝中静脉）,从而计算残余左半肝体积比;术后测定切取的右半肝重量、应用华西严律南公式计算标准肝脏体积（standard liver volume,SLV）,计算残余左半肝体积重量比,比较术前供肝CT测定全肝体积与SLV的差异。供体均行不含肝中静脉的右半供肝切除术。静脉复合麻醉,取双侧（后期改进为右侧）肋缘下并延至剑突的切口,游离右侧肝脏,确定切肝线,不阻断入肝血流,用超声吸引刀离断肝组织直至整个右半肝游离,依次阻断并切断肝右动脉,门静脉右支及肝右静脉,将供肝移至后台进行灌注及修整。了解供者术中情况,包括供体取肝手术时间、术中失血量、术中有否发现不适合作为供体的病例及其原因。了解供者术后随访情况,术后并发症采用Clavien系统分级评价。结果供体的术前CT供肝体积测定结果：全肝体积（1301±174）ml,右半肝体积（724±137）ml,残余左半肝体积比（45．5±6．9）％。实测值：右半肝重量（558±77）g,SLV（1055±129）ml,残余左半肝重量比（46．7±6．2）％,其中30％～35％者10例（6％）,〉35％者147例（94％）。CT测定供体全肝体积比SLV平均大23％。供体术中平均失血量493ml,手术时间（431±68）min。术中探查发现不适合作为供体而未完成右半肝切除4例,包括肝总管进入肝圆韧带左纵沟内再发出肝右管1例、多支肝右管1例、中度脂肪肝（超过30％的肝组织大泡型脂肪变性）1例和肝硬化1例。术后共54例发生61例次并发症,其中发生ClavienⅢ级及以上并发症18例次,包括胸腔积液12例次、肝功能不全2例次、门静脉血栓形成1例次、胆漏1例次、腹腔内出血1例次、切口裂开1例次,经对症治疗后均痊愈。所有供体恢复良好,随访3年均健康存活。结论术前准确掌握CT测定供肝体积的准确性和偏差程度,应用经临床验证有效的评估公式进行验证,并按正确切线断肝,对完成手术计划,保证供、受体安全具有重要的临床意义。     

腹腔镜肝癌切除术28例报告

目的探讨腹腔镜肝癌切除术的适应证和可行性。方法回顾性分析2002年3月至2007年10月完成的腹腔镜肝癌切除术28例患者临床资料。结果28例均成功在腹腔镜下完成手术。对于位于肝左外叶的肿瘤，选择规则性肝左外叶切除术；肿瘤位于肝脏边缘或右肝表面时，选择肝脏不规则切除术。平均手术时间95min（60～150min）。平均术中出血345ml（50～800ml）。切除标本最大体积11cm×9cm×7cm。患者术后24h均能下床活动，术后2～3d即能进食。术后平均住院时间8d（5～15d）。术后病理诊断为原发性肝细胞癌24例，结直肠癌肝转移4例。结论对位于肝脏边缘、右肝表面或者左肝外叶的肝癌行腹腔镜肝癌切除术是安全可行的。     

肝门部Glisson蒂交替血流阻断循Glisson鞘行肝右前叶下段解剖性切除术

目的探讨肝门部Glisson蒂交替血流阻断、循Glisson鞘行肝右前叶下段解剖性切除在肝癌手术中的应用。方法 15例肝右前叶下段肝癌患者中,8例采用肝门部Glisson蒂交替血流阻断、循Glisson鞘行肝右前叶下段解剖性切除术(A组)。7例采用间歇性第一肝门阻断(B组)行肝肿瘤局部切除术。对两组术中出血、术后肝功能情况进行比较。结果两组均无死亡病例,A组术中出血量、术后第1、3、5、7天的血清谷丙转氨酶(alanine transaminase,ALT)明显低于B组,两组比较差异具有统计学意义(P0.05)。结论肝门部Glisson蒂交替血流阻断、循Glisson鞘行肝右前叶下段解剖性切除术是减少术中出血和术后肝功能损害的有效的肝切除方法。     

肝破裂并胆管损伤20例手术治疗

目的：探讨肝破裂并胆管损伤的手术治疗。方法对我院2009年1月至2013年8月治疗的20例肝破裂并胆管损伤的病例资料进行回顾性总结分析。19例行肝毁损切除术,1例行肝脏清创修补术。胆管损伤均同时修复后T管引流。结果无围手术期死亡,术后胆瘘1例;胆道出血1例,是右肝动脉右后支的假性动脉瘤破裂引起,予肝动脉栓塞止血。结论非手术治疗期间高度怀疑肝破裂并胆管损伤时,尽早手术是抢救的最好方法。可行肝脏破裂修补术,或肝脏切除术,同时修复胆管损伤并放置T管,一旦发生胆道出血首先采用肝动脉栓塞止血。     

继发性肝癌的外科治疗

目的 确定继发性肝癌的肝切除的适应症、方法、安全性和有效性。方法 分析1992年3月至1999年5月的67例继发性肝癌之肝切除69次的随访资料,28．3％行左半肝切除,3％为右半肝切除．7．5％为左外叶切除,13．4％为左内叶切除,23．9％为右前叶切除,19．4％为右后叶切除．1．5%为部分肝叶切除或楔形切除,3％为微波刀切除,其中胰十二指肠切除并左半肝切除3例(4．5％)。结果 手术死亡1例(1．5%)．余之随访1～7年(平均5年),1、2、3、4、5年的生存率分别为28．36％、22．34％、19．40％、16．42％和11．94％．其中大肠癌生存大于5年者21．43％。结论 肝转移癌的外科切除是安全的．在很多患者是有效的,可提供有意义的长期生存和切除后部分获得治愈机会。我们推荐,任何肝转移癌患者、解剖分布的肿瘤切除后肝功良好和能耐受手术者应考虑切除。     

Ⅳ型肝门部胆管癌的治疗体会

目的探讨Ⅳ型肝门部胆管癌的初步治疗经验。方法收集2008年4月至2011年4月期间四川大学华西医院肝胆胰外科1个医疗组收治的20例Ⅳ型肝门部胆管癌患者的临床资料,对其术中及术后结果进行分析。结果 20例中行手术切除15例,切除率为75%。其中行根治性切除术10例,非根治性切除术5例;行左三肝+尾叶切除(右前右后肝管成形、肝管-空肠吻合+空肠-空肠Roux-en-Y吻合术)7例,行扩大右半肝切除+尾叶切除(左外左内肝管成形、肝管-空肠吻合+空肠-空肠Roux-en-Y吻合术)6例,行肝方叶切除(左外内、右前后肝管分别整形后行2个胆-肠吻合术)2例;其中2例因总胆红素>400 mmol/L而先行经皮肝穿刺胆管引流(PTCD)和门静脉栓塞(PVE)后再手术,1例行根治性切除术,另1例行非根治性切除术。不能切除者5例,其中3例因发生肝脏及远处广泛转移,行术中PTCD,另2例因肿瘤侵犯门静脉左右支,行术中T管引流、联合术后PTCD。行手术切除者术后1年生存率为100%,术后生存时间1～3年,平均1.5年;肿瘤未切除者生存3～6个月,平均4.2个月。本组无一例围手术期死亡。结论对于Ⅳ型肝门部胆管癌,术前应精确评估,力争切除肿瘤,解除胆管梗阻;如不能一期切除则行PTCD和PVE,力争二期切除。     

Giant haemangioma of the liver with haemangiodudenal fistula: the first reported case in literature

Giant liver haemangiomas are usually asymptomatic with normal liver function, which makes the course long and uneventful. The most commonly reported complications of giant haemangiomas are rupture with intraperitoneal haemorrhage that is either traumatic or non-traumatic, consumption coagulopathy, Budd–Chiari syndrome and congestive heart failure. We describe the first reported complications of a giant liver haemangioma as a fistula between the haemangioma and the gastrointestinal tract.     

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??Treatment of complicated primary hepatic lithiasis by combined right and left lobectomy??an analysis of 47 cases WANG Huai-Zhi, HE Zhen-Ping, BIE Ping, et al. Institute of Hepatobiliary Surgery of PLA, Southwest Hospital, the Third Military Medical University, Chongqing400038??China Corresponding author: WANG Huai-Zhi, E-mail??whuaizhi@gmail.com Abstract Objective To summarize the experience and evaluate the therapeutic effect of combined right and left lobectomy for complicated primary hepatic lithiasis. Methods To analyze retrospectively the clinical data of 47 patients suffering from complicated primary hepatic lithiasis underwent combined right and left lobectomy from Aug.1991 to Aug. 2007. Stones distribution, operation style, postoperative complications and therapeutic effects were evaluated. Results 15 patients out of 47 patients had underwent operations on bile duct. All of the patients have stones in both right lobe and left lobe. Out of 47 patients, 7 patients have stones in caudate lobe, 21 patients have stones in extrahepatic bile duct. 23 cased of biliary stricture were found during operations. All of the patients underwent combined right and left lobectomy. Out of 47 patients, 3 patients underwent the resection of biliary tree of right lobe, 6 patients underwent the resection of biliary tree of right posterior lobe. Additional procedures include exploration of common bile duct in 28 patients, chole-enterostomy(Roux-en-Y) in 19 patients and intrahepatic lithotomy through hepatic parenchyma. Two patients died perioperatively. Three patients had intraperitoneal infection after operation. One patient had residual stone in right anterior lobe. One patient had residual stone in left interior lobe. The follow-up time is from 16 months to 17 years.88.89% of patients has excellent life quality. Conclusion Combined right and left lobectomy has less complications, less residual stones, excellent long-term results, thus is one of the effective procedures treating complicated primary hepatic lithiasis.